Provider Demographics
NPI:1518601863
Name:RASMUSSEN, MAUREEN THERESE
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:THERESE
Last Name:RASMUSSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:THERESE
Other - Last Name:POPEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5736 SELWYN CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46614-6043
Mailing Address - Country:US
Mailing Address - Phone:941-592-6343
Mailing Address - Fax:
Practice Address - Street 1:211 N CEDAR ST
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-6923
Practice Address - Country:US
Practice Address - Phone:574-232-2666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-22
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34008707A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical