Healthcare Provider Details

I. General information

NPI: 1467461442
Provider Name (Legal Business Name): ANDREA MARIE THELEN B.S, M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 SMITH AVE N SUITE 100
SAINT PAUL MN
55102-2572
US

IV. Provider business mailing address

255 SMITH AVE N SUITE 100
SAINT PAUL MN
55102-2572
US

V. Phone/Fax

Practice location:
  • Phone: 651-310-1664
  • Fax: 651-310-1666
Mailing address:
  • Phone: 651-310-1664
  • Fax: 651-310-1666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: