Individual
GINA MARIE THEISZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
308 12TH AVE S, BUFFALO, MN 55313-2321
(763) 682-4400
(763) 682-1353
Mailing address
1321 13TH ST N, SAINT CLOUD, MN 56303-2613
(320) 252-5010
(320) 203-1855
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
18283
MN
Other
Enumeration date
11/23/2010
Last updated
08/30/2011
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