Charlotte Louise Stack, R.N., CNS

Primary specialty

Adult Psychiatric/Mental Health Clinical Nurse SpecialistTaxonomy code 364SP0809X

License

R0917850 Issued in MN

Practice address

882 SW 15TH St.
Forest Lake, MN 55025-1331

Phone

(651) 464-2194

Fax

(651) 464-5744

NPI assigned

Nov 7, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Certified Nurse Specialist, Registered Nurse

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lakes Area Human Services, Inc.

  • Community/Behavioral Health Agency
  • Forest Lake, MN
  • NPI 1700956646
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1700955648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "573 N DAY RD",
            "city": "SAINT CROIX FALLS",
            "state": "WI",
            "postal_code": "540249454",
            "telephone_number": "715-483-9688",
            "fax_number": "651-464-5744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "882 SW 15TH ST.",
            "city": "FOREST LAKE",
            "state": "MN",
            "postal_code": "550251331",
            "telephone_number": "651-464-2194",
            "fax_number": "651-464-5744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACK",
        "first_name": "CHARLOTTE",
        "middle_name": "LOUISE",
        "name_prefix": "Ms.",
        "credential": "R.N., CNS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SP0809X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health, Adult",
            "state": "MN",
            "license": "R0917850",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Spehar Guiding LLC
• Jacob Louis Spehar, MA, LPCC, LADC
• Heidi Marie Spetzman, LAMFT
• Diane Marie Spiess, PTA
• St. Croix Endodontics
• William Howard Stackpole, DDS
• Edward J Stec, D.D.S, M.S
• Rodney A Stensrud, DDS
• Connie Renee Stoner
• Suite Living Senior Care of Forest Lake

• Adult Psychiatric/Mental Health Clinical Nurse Specialist in Forest Lake, MN
• Providers in Forest Lake, MN by specialty
• Adult Psychiatric/Mental Health Clinical Nurse Specialist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.