Provider Demographics
NPI:1538118427
Name:RASK, KRISTINA J (PHD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:J
Last Name:RASK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 W LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-9056
Mailing Address - Country:US
Mailing Address - Phone:734-426-0032
Mailing Address - Fax:734-426-0034
Practice Address - Street 1:3700 W LIBERTY RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-9056
Practice Address - Country:US
Practice Address - Phone:734-426-0032
Practice Address - Fax:734-426-0034
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002677103TC0700X
MI6301016641103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA253567OtherANTHEM
VA007710321Medicaid