Healthcare Provider Details

I. General information

NPI: 1326970047
Provider Name (Legal Business Name): ELISABETH AUDREY THEISEN MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 342
SILVER LAKE MN
55381-0342
US

IV. Provider business mailing address

250 GAUGER ST NE
HUTCHINSON MN
55350-1707
US

V. Phone/Fax

Practice location:
  • Phone: 320-864-2530
  • Fax:
Mailing address:
  • Phone: 320-583-0424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number351721
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: