DEPARTMENT OF INSURANCE

Name	Theiss, Mary Donna	DOIID	611888	NAIC NPN	8518292

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Resident	Agent	Property	1/14/2022	10/31/2025
Active	Resident	Agent	Life	1/14/2022	10/31/2025
Active	Resident	Agent	Health	1/14/2022	10/31/2025
Active	Resident	Agent	Casualty	1/14/2022	10/31/2025

*If a status is Pending, Pending Replacement,or the record displays Affidavit on File, click on them for more details.

No License Renewal Information

NOTE: Licensee may renew up to 6 months prior to Next Compliance Date. Licensees subject to CE must complete CE requirements before Next Compliance Date in order to successfully complete the License Renewal Process.

Address Information

Type	Address
Business / Home Office	10602 Timberwood Cir Ste 12 Louisville, KY 40223
Residence	Not Public Information

Phone Information

Type	Phone
Business / Home Office	(502) 423-9335