Provider Demographics
NPI:1275137739
Name:RHYNER, STACEY NICHOLE (LICSW)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:NICHOLE
Last Name:RHYNER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 PAYNE AVE STE B2
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55130-4280
Mailing Address - Country:US
Mailing Address - Phone:218-398-2639
Mailing Address - Fax:
Practice Address - Street 1:925 PAYNE AVE STE B2
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55130-4280
Practice Address - Country:US
Practice Address - Phone:218-398-2639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2023-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN294171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical