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Stacy Kannenberg
NPI 1790649986 · on the registry since 2025
Practice
- Address
- 1516 E Kelly Ave
Peoria Heights, IL 61616 - Phone
- (309) 657-8779
Registry record
- Primary taxonomy
- 390200000X
390200000X
- Also registered as
- 2255A2300X
- Licence states on file
- IL
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2025-12-11
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Illinois