Provider Demographics
NPI:1205295953
Name:RASCH, ELLEN MARIE (MS,RD,CD)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:MARIE
Last Name:RASCH
Suffix:
Gender:F
Credentials:MS,RD,CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W243N2755 CREEKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-5881
Mailing Address - Country:US
Mailing Address - Phone:262-902-5654
Mailing Address - Fax:
Practice Address - Street 1:W243N2755 CREEKSIDE DR
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-5881
Practice Address - Country:US
Practice Address - Phone:262-902-5654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1728-29133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered