Individual
JAY LEE THEISEN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MSW LICSW
Contact information
Practice address
2649 PARK AVE, MINNEAPOLIS, MN 55407
(612) 676-1604
(612) 379-8235
Mailing address
2649 PARK AVE, MINNEAPOLIS, MN 55407
(612) 676-1604
(612) 379-8235
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
13782
MN
Other
Enumeration date
04/08/2006
Last updated
07/08/2007
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