Provider Demographics
NPI:1396825089
Name:STOECKEL, MARCELLA LOUISE (MA)
Entity Type:Individual
Prefix:
First Name:MARCELLA
Middle Name:LOUISE
Last Name:STOECKEL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28361 LILY ST NW
Mailing Address - Street 2:
Mailing Address - City:ISANTI
Mailing Address - State:MN
Mailing Address - Zip Code:55040-5943
Mailing Address - Country:US
Mailing Address - Phone:763-444-4829
Mailing Address - Fax:
Practice Address - Street 1:133 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008-1552
Practice Address - Country:US
Practice Address - Phone:763-689-9407
Practice Address - Fax:763-552-0164
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP-0665103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist