Gina Marie Theisz, LICSW
Social Worker, Clinical in Buffalo, MN. Individual provider (NPI-1).
NPI number1407158496
StatusActive
Last updated in NPPESAug 30, 2011
Details
- NPI
- 1407158496
- Entity type
- Individual (NPI-1)
- Name
- Gina Marie Theisz
- Credential
- LICSW
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Nov 23, 2010
- Last updated
- Aug 30, 2011
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | 18283 | MN | Yes |
Practice location
308 12th Ave SBuffalo, MN 55313-2321
Phone 763-682-4400 · Fax 763-682-1353
Mailing address
1321 13th St NSaint Cloud, MN 56303-2613
Phone 320-252-5010 · Fax 320-203-1855
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All 23 Clinical Social Worker providers in Buffalo · All 582 providers in Buffalo
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