Provider Demographics
NPI:1336286202
Name:EINSMAN, MARIO WALTER (MS)
Entity Type:Individual
Prefix:MR
First Name:MARIO
Middle Name:WALTER
Last Name:EINSMAN
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 185
Mailing Address - Street 2:SUITE 4A
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-0185
Mailing Address - Country:US
Mailing Address - Phone:507-452-5033
Mailing Address - Fax:507-452-5183
Practice Address - Street 1:111 MARKET ST
Practice Address - Street 2:SUITE 4A
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-5532
Practice Address - Country:US
Practice Address - Phone:507-452-5033
Practice Address - Fax:507-452-5183
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN91201041C0700X
WI4231-1231041C0700X
MN656106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist