Active NPI
Gina Marie Theisz, LICSW
- Clinical Social Worker
- Buffalo, MN
National Provider Identifier
1407158496
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 18283
- Practice address
- 308 12TH Ave S
Buffalo, MN 55313-2321 - Phone
- (763) 682-4400
- Fax
- (763) 682-1353
- NPI assigned
- Nov 23, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 18283 | MN | Primary |
Addresses
Primary practice location
308 12TH Ave S
Buffalo, MN 55313-2321
Mailing address
1321 13TH St N
Saint Cloud, MN 56303-2613
Phone (320) 252-5010
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18283 | MN | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1290470400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1314662400000",
"number": "1407158496",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1321 13TH ST N",
"city": "SAINT CLOUD",
"state": "MN",
"postal_code": "563032613",
"telephone_number": "320-252-5010",
"fax_number": "320-203-1855"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "308 12TH AVE S",
"city": "BUFFALO",
"state": "MN",
"postal_code": "553132321",
"telephone_number": "763-682-4400",
"fax_number": "763-682-1353"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THEISZ",
"first_name": "GINA",
"middle_name": "MARIE",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-11-23",
"last_updated": "2011-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "18283",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Buffalo, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.