Provider Demographics
NPI:1962835777
Name:THEISEN, JACQUELINE MARIE (NCC, LPCC)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:MARIE
Last Name:THEISEN
Suffix:
Gender:F
Credentials:NCC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 3RD AVE NW
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:MN
Mailing Address - Zip Code:55350-1623
Mailing Address - Country:US
Mailing Address - Phone:320-455-9888
Mailing Address - Fax:320-587-5390
Practice Address - Street 1:225 3RD AVE NW
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-1623
Practice Address - Country:US
Practice Address - Phone:320-455-9888
Practice Address - Fax:320-587-5390
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN284917101YM0800X
MNCC00794101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health