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NPI Code Detail

MEDICARE: STACEY NICHOLE RHYNER LICSW

MEDICARE:   STACEY NICHOLE RHYNER  LICSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker29417MN

General Provider Information

NPI Number : 1275137739
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACEY NICHOLE RHYNER LICSW
Provider Business Mailing Address
First Line : 434 HAYWARD AVE N
Second Line :
City : OAKDALE
State : MN
Zip : 55128-5379
Country : US
Telephone Number : 218-398-2639
Fax Number :
Provider Business Practice Location Address
First Line : 434 HAYWARD AVE N
Second Line :
City : OAKDALE
State : MN
Zip : 55128-5379
Country : US
Telephone Number : 218-398-2639
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/25/2020
Last Update Date : 05/13/2026

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Directions to “ STACEY NICHOLE RHYNER LICSW” Practice Location

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