Provider Demographics
NPI:1942337241
Name:RASMUSSEN, CAROL R (LAC)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:R
Last Name:RASMUSSEN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 27TH ST W
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-2408
Mailing Address - Country:US
Mailing Address - Phone:701-774-0686
Mailing Address - Fax:
Practice Address - Street 1:209 2ND ST SE
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:MT
Practice Address - Zip Code:59270-4305
Practice Address - Country:US
Practice Address - Phone:406-433-4097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1055101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)