Provider Demographics
NPI:1548212327
Name:HERKNER, STACEY M (LMSW)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:M
Last Name:HERKNER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:M
Other - Last Name:BERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:3785 BAY RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-2433
Mailing Address - Country:US
Mailing Address - Phone:989-791-2455
Mailing Address - Fax:989-791-1392
Practice Address - Street 1:1714 EASTMAN AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-4216
Practice Address - Country:US
Practice Address - Phone:989-631-5390
Practice Address - Fax:989-631-0488
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2022-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801068003104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM16220008Medicare ID - Type Unspecified