STACEY LYNN NELSON (NPI# 1760790828) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760790828 |
| Entity Type | Individual |
| Full Name | STACEY LYNN NELSON |
| Other Name | STACEY LYNN ALLEN |
| Credential | PSY.D |
| Practice Address |
11280 86th Ave N Maple Grove MN 55369-4510 |
| Mailing Address |
13303 180 1/2 Cir Nw Elk River MN 55330-5604 |
| Practice Telephone | 7634007828 |
| Practice Fax Number | 7634007444 |
| Mailing Telephone | 9522003663 |
| Mailing Fax Number | 7634007444 |
| Enumeration Date | 2010-09-22 |
| Last Update Date | 2014-08-01 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
LP5661 | MN | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 943400400 | 05 | |
| MN | MEDICARE PTAN | H400153967 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922489723 | Stacey D Nelson | Social Worker | 11048 Cardiff Ln, Frisco, TX 75035-6673 | 2015-06-17 |
| 1215346259 | Stacey Nelson | Counselor | 4215 9th Ave S, Fargo, ND 58103-2018 | 2014-08-04 |
| 1740546050 | Stacey Nelson | Licensed Practical Nurse | 2634 Pearl St, Detroit, MI 48209-3700 | 2012-04-11 |
| 1609942655 | Stacey Nelson | Social Worker | 4371 E 72nd Ave, Commerce City, CO 80022-1471 | 2006-11-28 |
| 1033293279 | Stacey J Nelson | Marriage & Family Therapist | 1200 N Federal Hwy Ste 200, Boca Raton, FL 33432-2813 | 2006-10-24 |
| 1598204109 | Stacey Nelson | Registered Nurse | 777 Murphy Rd, Medford, OR 97504-8425 | 2017-02-15 |
| 1770839029 | Stacey Nelson | Registered Nurse | 1704 E Broadway Ave, Maryville, TN 37804 | 2012-07-24 |
| 1225384589 | Stacey White Nelson | Counselor | 1307 E Elm St, Athens, AL 35611-5318 | 2012-07-24 |
| 1912187329 | Stacey Lynn Nelson | Nurse Anesthetist, Certified Registered | 77 W Forest Ave Ste 117, Flagstaff, AZ 86001-1482 | 2007-11-14 |
| 1538292834 | Stacey Nelson | Counselor | 914 E Broadway, Louisville, KY 40204-1037 | 2007-03-14 |
| Street Address |
11280 86TH AVE N |
| City | MAPLE GROVE |
| State | MN |
| Zip Code | 55369-4510 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578697173 | Marci Marie Mueller Theisen | Psychologist | 11280 86th Ave N, Maple Grove, MN 55369-4510 | 2007-03-15 |
| 1235738287 | Alicia Bethany Losier | Marriage & Family Therapist | 11280 86th Ave N, Maple Grove, MN 55369-4510 | 2020-10-21 |
| 1245846740 | Elizabeth A Braun | Nurse Practitioner | 11280 86th Ave N, Maple Grove, MN 55369-4510 | 2020-09-20 |
| 1871123125 | Rachel M Haug | Psychologist | 11280 86th Ave N, Maple Grove, MN 55369-4510 | 2020-01-24 |
| 1972090538 | Kelley Dyanne Aliffi | Marriage & Family Therapist | 11280 86th Ave N, Maple Grove, MN 55369-4510 | 2018-04-19 |
| 1346758877 | Abby Rose Swandal | Counselor | 11280 86th Ave N, Maple Grove, MN 55369-4510 | 2018-01-18 |
| 1366968281 | Lauren Marie Simensen | Social Worker | 11280 86th Ave N, Maple Grove, MN 55369 | 2017-08-22 |
| 1851816227 | Kelly Berscheit | Social Worker | 11280 86th Ave N, Maple Grove, MN 55369-4510 | 2017-08-07 |
| 1629511027 | Lorilee Virnig | Counselor | 11280 86th Ave N, Maple Grove, MN 55369-4510 | 2016-12-02 |
| 1023423027 | Kathryn Schuster | Social Worker | 11280 86th Ave N, Maple Grove, MN 55369-4510 | 2014-06-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376144188 | Bonnie Rose Theis | Counselor | 24 3rd Ave Ne, Unit B, Osseo, MN 55369 | 2020-11-06 |
| 1356976328 | Kirollos Samir Hanna | Pharmacist | 14500 99th Ave N, Suite 0a030, Maple Grove, MN 55369 | 2020-03-10 |
| 1396395463 | Susan Osborne | Technician | 9240 Orchid Lane, Maple Grove, MN 55369 | 2019-09-19 |
| 1710537196 | Janis Langsdale | Technician | 11070 108 Avenue North, Maple Grove, MN 55369 | 2019-09-17 |
| 1043724552 | Tracey Wahlquist | Speech-Language Pathologist | 11100 86th Ave N, Maple Grove, MN 55369 | 2017-11-20 |
| 1154860005 | Kayla Uptagrafft | Specialist/Technologist | 9555 Upland Lane Norh, Maple Grove, MN 55369 | 2017-02-13 |
| 1750823324 | Jennifer Ranallo | Social Worker | 9600 Upland Ln N Ste 110, Maple Grove, MN 55369 | 2016-11-13 |
| 1558723999 | Debra Grace Boersma | Advanced Practice Midwife | 9825 Hospital Dr#205, Maple Grove, MN 55369 | 2016-03-24 |
| 1396129433 | Maple Grove Smiles Dentistry, PC | Dentist | 12775 Elm Creek Blvd N, Maple Grove, MN 55369 | 2015-07-18 |
| 1558755900 | Krista Newman | Counselor | 24 3rd St Nw, Unit B, Osseo, MN 55369 | 2015-03-24 |
| Find all providers in zip 55369 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790180503 | Iris Song | Psychologist | 7979 Ranchview Ln N, Maple Grove, MN 55311-2106 | 2014-10-23 |
| 1992940746 | Justin Coulter | Psychologist | 7236 Forestview Lane N., Maple Grove, MN 55369 | 2008-12-09 |
| 1578697173 | Marci Marie Mueller Theisen | Psychologist | 11280 86th Ave N, Maple Grove, MN 55369-4510 | 2007-03-15 |
| 1760532980 | Lynn M Powers | Psychologist | 12403 74th Av N, Maple Grove, MN 55369 | 2007-01-11 |
| 1942223714 | Marcia M Rogers | Psychologist | 7382 Kirkwood Ct, Maple Grove, MN 55369-5270 | 2006-07-25 |
| 1972955268 | Cindi Brockhaus | Psychologist | 13603 80th Cir N, Maple Grove, MN 55369 | 2016-07-11 |
| 1124490578 | Teresa Biehn | Psychologist | 9555 Upland Ln N, Maple Grove, MN 55369-4485 | 2015-10-26 |
| 1033585914 | Michaela Monetti | Psychologist | 14500 99th Ave N, Maple Grove, MN 55369-4730 | 2015-08-14 |
| 1326463944 | Heidi Kopacek | Psychologist | 11280 86th Ave N, Maple Grove, MN 55369-4510 | 2014-02-19 |
| 1124370358 | Elizabeth Anne Heidenreich | Psychologist | 13603 80th Cir N, Maple Grove, MN 55369-8961 | 2012-10-11 |
| Find all providers in MAPLE GROVE | ||||
| City | MAPLE GROVE |
| Zip Code | 55369 |
Please comment or provide details below to improve the information on STACEY LYNN NELSON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.