Provider Demographics
NPI:1720392160
Name:AHRENSTORFF, STACEY LYNN HOFER (MS)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:LYNN HOFER
Last Name:AHRENSTORFF
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1174 160TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE PARK
Mailing Address - State:IA
Mailing Address - Zip Code:51347-7025
Mailing Address - Country:US
Mailing Address - Phone:712-320-9524
Mailing Address - Fax:712-832-3584
Practice Address - Street 1:1004 - 22ND ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:IA
Practice Address - Zip Code:51351
Practice Address - Country:US
Practice Address - Phone:712-320-9524
Practice Address - Fax:712-832-3584
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04680101Y00000X
IA00348101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor