Individual
DR. STACEY LYNN NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D
Contact information
Practice address
19230 EVANS ST NW STE 109, ELK RIVER, MN 55330-1079
(952) 213-5648
(952) 213-5663
Mailing address
19230 EVANS ST NW STE 109, ELK RIVER, MN 55330-1079
(952) 213-5648
(763) 400-7444
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP5661
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
943400400
—
MN
01
—
H400153967
MEDICARE PTAN
MN
Enumeration date
09/22/2010
Last updated
12/30/2022
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