Provider Demographics
NPI:1629142856
Name:RASMUSSEN, CARA MICHELE (AU D)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:MICHELE
Last Name:RASMUSSEN
Suffix:
Gender:F
Credentials:AU D
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:M
Other - Last Name:ROE-RASMUSSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AU D
Mailing Address - Street 1:2848 BELLEGLADE CT SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-8011
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2825 28TH ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49512-1607
Practice Address - Country:US
Practice Address - Phone:616-600-9650
Practice Address - Fax:616-600-9650
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
237600000X
MI1601000208231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M74460256Medicare PIN