Provider Demographics
NPI:1225627110
Name:STOECKEL, MARYANN MICHELLE (LADC, LPCC)
Entity Type:Individual
Prefix:MRS
First Name:MARYANN
Middle Name:MICHELLE
Last Name:STOECKEL
Suffix:
Gender:F
Credentials:LADC, LPCC
Other - Prefix:MRS
Other - First Name:MARYANN
Other - Middle Name:MICHELLE
Other - Last Name:WEINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26514 DOLPHIN ST NW
Mailing Address - Street 2:
Mailing Address - City:ZIMMERMAN
Mailing Address - State:MN
Mailing Address - Zip Code:55398
Mailing Address - Country:US
Mailing Address - Phone:763-286-8191
Mailing Address - Fax:
Practice Address - Street 1:701 DELLWOOD ST S # ED
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008-1920
Practice Address - Country:US
Practice Address - Phone:763-689-7700
Practice Address - Fax:612-262-9035
Is Sole Proprietor?:No
Enumeration Date:2021-01-14
Last Update Date:2024-01-12
Deactivation Date:2021-03-18
Deactivation Code:
Reactivation Date:2022-08-09
Provider Licenses
StateLicense IDTaxonomies
MN101YM0800X
MN3187101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health