Provider Demographics
NPI:1821051129
Name:RASMUSSEN, BONNIE L (MA LP)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:L
Last Name:RASMUSSEN
Suffix:
Gender:F
Credentials:MA LP
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:L
Other - Last Name:BAUMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1930 COON RAPIDS BOULEVARD
Mailing Address - Street 2:FAMILY LIFE MENTAL HEALTH CENTER
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433
Mailing Address - Country:US
Mailing Address - Phone:763-427-7964
Mailing Address - Fax:763-427-7976
Practice Address - Street 1:1930 COON RAPIDS BOULEVARD
Practice Address - Street 2:FAMILY LIFE MENTAL HEALTH CENTER
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433
Practice Address - Country:US
Practice Address - Phone:763-427-7964
Practice Address - Fax:763-427-7976
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3426103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HP35484OtherHEALTH PARTNERS
MN1035249OtherPREFERRED ONE
MN169333600Medicaid
MN139M5RAOtherBCBS
6277900OtherUBH