Provider Demographics
NPI:1093906414
Name:RASMUSSON, LYNETTE ADELE (LSW, LAC)
Entity Type:Individual
Prefix:MRS
First Name:LYNETTE
Middle Name:ADELE
Last Name:RASMUSSON
Suffix:
Gender:F
Credentials:LSW, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 BURNT BOAT DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0801
Mailing Address - Country:US
Mailing Address - Phone:701-663-1771
Mailing Address - Fax:701-663-1771
Practice Address - Street 1:1720 BURNT BOAT DR
Practice Address - Street 2:SUITE 200
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0801
Practice Address - Country:US
Practice Address - Phone:701-663-1771
Practice Address - Fax:701-663-1771
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1373101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)