Provider Demographics
NPI:1760462006
Name:RASMUSSEN, PAUL C (LCSW)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:C
Last Name:RASMUSSEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2312 PRESTON ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-4115
Mailing Address - Country:US
Mailing Address - Phone:801-486-7010
Mailing Address - Fax:
Practice Address - Street 1:1020 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84101-3176
Practice Address - Country:US
Practice Address - Phone:801-536-6500
Practice Address - Fax:801-536-6520
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT133270-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT261929OtherDESERET MUTUAL
UT942938348RA1OtherEDUCATOR'S MUTUAL
UTR79743OtherMEDICARE ADVANTAGE PLANS
UT107001392101OtherINTERMOUNTAIN HEALTH CARE
UT942938348015OtherCHAMPUS
UT942938348RA1OtherEDUCATOR'S MUTUAL