| Carleen Theisen, | |
|
411 3rd St N, Waite Park, MN 56387-1177 | |
| (320) 230-2013 | |
| (320) 251-4175 |
| Full Name | Carleen Theisen |
|---|---|
| Gender | Female |
| Speciality | Clinical Social Worker |
| Experience | 5 Years |
| Location | 411 3rd St N, Waite Park, Minnesota |
| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881461143 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 29939 (Minnesota) | Primary |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Central Minnesota Mental Health Center | 4486555877 | 19 |
| Entity Name | Central Minnesota Mental Health Center |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1831177195 PECOS PAC ID: 4486555877 Enrollment ID: O20040119000248 |
| Mailing Address | Practice Location Address |
|---|---|
| Carleen Theisen, 254 12th Ave N, Waite Park, MN 56387-1035 Ph: (320) 250-0240 | Carleen Theisen, 411 3rd St N, Waite Park, MN 56387-1177 Ph: (320) 230-2013 |
Mckenzie Bomstad, MSW, LICSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 411 3rd St N, Waite Park, MN 56387 Phone: 320-253-4120 | |
Ms. Dawn Marie Kuhl, MSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 818 2nd St S, Suite 180, Waite Park, MN 56387 Phone: 320-257-1800 | |
Jean M Bjerke, MA, LICSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 110 2nd St S, Suite 303, Waite Park, MN 56387 Phone: 320-253-4080 Fax: 320-253-4088 | |
Amanda Joy Schultz, LICSW Clinical Social Worker Medicare: Accepting Medicare Assignments Practice Location: 110 2nd Ave S, Waite Park, MN 56387 Phone: 320-252-2976 |