Provider Demographics
NPI:1467471789
Name:RASMUSSEN, DENNIS D (PHD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:D
Last Name:RASMUSSEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 MERIDIAN CIR
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-8656
Mailing Address - Country:US
Mailing Address - Phone:608-826-0424
Mailing Address - Fax:
Practice Address - Street 1:3901 MERIDIAN CIR
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-8656
Practice Address - Country:US
Practice Address - Phone:608-826-0424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0636103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39006400Medicaid
WI84150002Medicare ID - Type Unspecified