Provider Demographics
NPI:1609368844
Name:RASMUSSEN, TESSA MARIE (SLP)
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:MARIE
Last Name:RASMUSSEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 32ND ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-6304
Mailing Address - Country:US
Mailing Address - Phone:701-532-1507
Mailing Address - Fax:701-532-1529
Practice Address - Street 1:4500 36TH AVE S STE 200
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-5275
Practice Address - Country:US
Practice Address - Phone:701-532-1507
Practice Address - Fax:701-532-1529
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1649235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1476357Medicaid