Charlene Marie Hanisch Theisen, MS LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Practice address

850 1St Ave South
Saint Cloud, MN 56301-4498

Phone

(320) 308-3171

Fax

(320) 308-0959

NPI assigned

Jun 22, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 6

Other names 1

• Charlene Marie Carroll Hanisch Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Minnesota State Colleges and Universities

  dba St. Cloud State University Medical Clinic and Counseling

  • Student Health Clinic/Center
  • Saint Cloud, MN
  • NPI 1013993401
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744761600000",
    "number": "1437195641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 4TH AVE S",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563014498",
            "telephone_number": "320-308-3171",
            "fax_number": "320-308-0959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 1ST AVE SOUTH",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563014498",
            "telephone_number": "320-308-3171",
            "fax_number": "320-308-0959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANISCH THEISEN",
        "first_name": "CHARLENE",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "MS LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-22",
        "last_updated": "2025-04-16",
        "certification_date": "2025-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MN",
            "license": "12147",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "49F67CA",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "796113800",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "6256246",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "922241027913",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP33738",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "151607C851",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHARLENE",
            "last_name": "CARROLL HANISCH",
            "middle_name": "MARIE",
            "credential": "MS LICSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Samantha Jo Handley, DNP, APRN, CNP
• Roger P Handrich, MD
• Janet Mary Handrigan, MD
• Jordan Wayne Handy, DNP, CRNA
• Lavendar Marie Hangge
• Laura Martha Hanley, MSW, LICSW
• Anjelina Hannon
• Denise Hansen, LICSW
• Denise Marie Hansen, PT
• Stacie Hansen, PT

• Clinical Social Worker in Saint Cloud, MN
• Providers in Saint Cloud, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.