Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

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

Q: 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.

Q: 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.

Q: When was this NPI record last updated?

The NPPES record for Stacy Kannenberg was last updated on October 9, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 days 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.

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: October 9, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Oct 9, 2026, Dec 11, 2025 (2 updates tracked since 2025).

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About Stacy Kannenberg Lsw NPPES

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

STACY KANNENBERG LSW (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 KANNENBERGCredential: LSW

Location Address1516 E KELLY AVEPeoria Heights, IL 61616-6512

Mailing Address1401 W Green StChampaign, IL 61821-3822 · (309) 657-8779

Phone(309) 657-8779

Sole ProprietorNo

Enumeration DateDecember 11, 2025

Last NPPES UpdateOctober 9, 20262 updates tracked since enumeration

NPPES CertifiedOctober 9, 2026

✔ 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 ListedSocial WorkerTaxonomy 104100000X · License 150.119170 (IL)

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 October 9, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 days 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.