NPI Code Detail JSON Logo

1437195641 NPI number — CHARLENE MARIE HANISCH THEISEN MS LICSW

NPI Number: 1437195641
Health Care Provider/Practitioner: CHARLENE MARIE HANISCH THEISEN MS LICSW

Information about “1437195641” NPI (CHARLENE MARIE HANISCH THEISEN MS LICSW) exists in 1437195641 in HTML format HTML  |  1437195641 in plain Text format TXT  |  1437195641 in PDF (Portable Document Format) PDF  |  1437195641 in an XML format XML  formats.

NPI Number : 1437195641 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1437195641",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HANISCH THEISEN",
    "FirstName": "CHARLENE",
    "MiddleName": "MARIE",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "MS LICSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "CARROLL HANISCH",
    "OtherFirstName": "CHARLENE",
    "OtherMiddleName": "MARIE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "MS LICSW",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "720 4TH AVE S",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAINT CLOUD",
    "MailingAddressStateName": "MN",
    "MailingAddressPostalCode": "56301-4498",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "320-308-3171",
    "MailingAddressFaxNumber": "320-308-0959",
    "FirstLinePracticeLocationAddress": "850 1ST AVE SOUTH",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAINT CLOUD",
    "PracticeLocationAddressStateName": "MN",
    "PracticeLocationAddressPostalCode": "56301-4498",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "320-308-3171",
    "PracticeLocationAddressFaxNumber": "320-308-0959",
    "EnumerationDate": "06/22/2006",
    "LastUpdateDate": "04/16/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "104100000X",
          "TaxonomyName": "Social Worker",
          "LicenseNumber": "12147",
          "LicenseNumberStateCode": "MN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.