Provider Demographics
NPI:1417330499
Name:RASMUSSEN, WYATT C (AUD)
Entity Type:Individual
Prefix:
First Name:WYATT
Middle Name:C
Last Name:RASMUSSEN
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 CENTRAL AVE W
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-3969
Mailing Address - Country:US
Mailing Address - Phone:406-727-6577
Mailing Address - Fax:406-727-2354
Practice Address - Street 1:1220 CENTRAL AVE W
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404-3969
Practice Address - Country:US
Practice Address - Phone:406-727-6577
Practice Address - Fax:406-727-2354
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-08
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSLP-AU-LIC-5874231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist