Individual provider · Type 1 NPI
Stacy Kannenberg, LSW
Student in an Organized Health Care Education/Training Program · Peoria Heights, IL
Practice location
1516 E Kelly Ave
Peoria Heights, IL 61616-6512
Mailing address
1401 W Green St
Champaign, IL 61821-3822
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Social Worker | 104100000X | 150.119170 (IL) |
| Student in an Organized Health Care Education/Training Program Primary | 390200000X | None listed |
Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
About NPI 1790649986
Stacy Kannenberg, LSW's National Provider Identifier is 1790649986, issued on Dec 11, 2025. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Peoria Heights, IL. The record was last updated on Oct 9, 2026.