Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Gina Marie Theisz, LICSW

Individual provider Clinical Social Worker · NPI 1407158496

Gina Marie Theisz, LICSW is a Clinical Social Worker in Buffalo, Minnesota. Licensed in Minnesota. Registered with an NPI since 2010.

Licensed in
MN
In the registry since
2010
What do these letters mean?
LICSW — Licensed Independent Clinical Social Worker
The title some states use for an independently practising clinical social worker.

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Practice location Address checks out

308 12th Ave S
Buffalo, MN 55313-2321
Phone: (763) 682-4400
Fax: (763) 682-1353
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 18283 (MN)

Record details

NPI number1407158496
Entity typeIndividual (Type 1)
GenderFemale
Credentials LICSW
Sole proprietorNo
NPI enumeratedNovember 23, 2010
Last updated in NPPESAugust 30, 2011

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