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STACY KANNENBERG
NPI 1790649986
Student in an Organized Health Care Education/Training Program in Peoria Heights, IL

Active since December 11, 2025
1516 E KELLY AVE, PEORIA HEIGHTS, IL 61616(309) 657-8779 Get Directions Write a Review

NPPES record last updated: December 11, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Stacy Kannenberg NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

STACY KANNENBERG (NPI 1790649986) is an individual student in an organized health care education/training program in Peoria Heights, Illinois and active in the NPI registry since December 2025.

NPPES Registry Identity

NPI1790649986
Entity TypeIndividualFemale
Primary Taxonomy390200000X
Provider Legal NameSTACY KANNENBERG
Location Address1516 E KELLY AVEPeoria Heights, IL 61616-6512
Mailing Address1516 E Kelly AvePeoria Heights, IL 61616-6512 · (309) 657-8779
Phone(309) 657-8779
Sole ProprietorNo
Enumeration DateDecember 11, 2025
NPPES CertifiedDecember 11, 2025
✔ NPI 1790649986 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
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.
Also ListedSpecialist/Technologist · Athletic TrainerTaxonomy 2255A2300X
1516 E KELLY AVE, Peoria Heights, IL 61616
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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Stacy Kannenberg's NPI number?

The NPI number for Stacy Kannenberg is 1790649986. It was assigned to this individual provider in the NPPES registry on December 11, 2025.

Where is Stacy Kannenberg located?

Stacy Kannenberg practices at 1516 E Kelly Ave, Peoria Heights, IL 61616. The listed phone number is (309) 657-8779.

What is Stacy Kannenberg's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

When was this NPI record last updated?

The NPPES record for Stacy Kannenberg was last updated on December 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.