Individual
MS. ROBERTA JO THEIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSE
Contact information
Practice address
ROBERTA J THEIS, 8010 60TH AVE. NORTH, MINNEAPOLIS, MN 55428
(763) 208-3784
(763) 208-3784
Mailing address
ROBERTA J THEIS, 8010 60TH AVE. NORTH, MINNEAPOLIS, MN 55428
(763) 208-3784
(763) 208-3784
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP1134
MN
1041C0700X
Clinical Social Worker
08691
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
40G39TH
GROUP BLUE CROSS BLUE SHI
MH
01
—
40G40TH
INDIVIDUAL BLUE CROSS BLU
MN
05
—
622252800
—
MN
Enumeration date
01/22/2007
Last updated
04/03/2019
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