Provider Demographics
NPI:1912559402
Name:ASMUSSEN, HEATHER (BCBA; LABA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:ASMUSSEN
Suffix:
Gender:F
Credentials:BCBA; LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46322 217TH ST
Mailing Address - Street 2:
Mailing Address - City:VOLGA
Mailing Address - State:SD
Mailing Address - Zip Code:57071-6904
Mailing Address - Country:US
Mailing Address - Phone:605-270-7881
Mailing Address - Fax:
Practice Address - Street 1:1103 2ND AVE SE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-4512
Practice Address - Country:US
Practice Address - Phone:605-222-3847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD026-ABA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst