Provider Demographics
NPI:1073770731
Name:RASMUSSEN, KRISTA A (APSW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:A
Last Name:RASMUSSEN
Suffix:
Gender:F
Credentials:APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 KINGS LYNN RD
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:WI
Mailing Address - Zip Code:53589-4925
Mailing Address - Country:US
Mailing Address - Phone:608-205-2488
Mailing Address - Fax:
Practice Address - Street 1:301 TROY DR
Practice Address - Street 2:COTTAGE B
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-1521
Practice Address - Country:US
Practice Address - Phone:608-663-5912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI126536-1211041C0700X
WI1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43712600Medicaid