Individual
MS. CHARLENE MARIE HANISCH THEISEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS LICSW
Contact information
Practice address
850 1ST AVE SOUTH, SAINT CLOUD, MN 56301-4498
(320) 308-3171
(320) 308-0959
Mailing address
720 4TH AVE S, SAINT CLOUD, MN 56301-4498
(320) 308-3171
(320) 308-0959
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
12147
MN
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
151607C851
UCARE
—
01
—
49F67CA
BCBS
—
01
—
6256246
MEDICA
—
05
—
796113800
—
MN
01
—
922241027913
PREFERRED ONE
—
01
—
HP33738
HEALTH PARTNERS
—
Enumeration date
06/22/2006
Last updated
04/16/2025
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