Individual
GLYNIS N THIESSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS LP
Contact information
Practice address
617 OAK ST, BRAINERD, MN 56401-3610
(218) 829-7140
Mailing address
617 OAK ST, BRAINERD, MN 56401-3610
(218) 829-7140
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
4630
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
115826
115826
MN
01
—
6281371
MEDICA
MN
01
—
62G75TH
BCBS
MN
01
—
848980
ARAZ
MN
Enumeration date
07/31/2006
Last updated
07/09/2007
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