Stacy Kannenberg

NPI #1790649986 in Peoria Heights, Illinois

Provider Information

NPI Number: 1790649986
Entity Type: Individual
Name: Stacy Kannenberg
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Student in an Organized Health Care Education/Training Program
Enumeration Date: Dec 11, 2025
Last Updated: Dec 11, 2025

Practice Location

Address: 1516 E KELLY AVE
City: Peoria Heights
State: Illinois
ZIP Code: 61616-6512
Phone: (309) 657-8779

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Student in an Organized Health Care Education/Training Program	390200000X	Primary
Specialist/Technologist - Athletic Trainer — Athletic Trainer	2255A2300X

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