Provider Demographics
NPI:1427760990
Name:RASMUSSEN, KYLEE ANN
Entity type:Individual
Prefix:
First Name:KYLEE
Middle Name:ANN
Last Name:RASMUSSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1491 S 565 W
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-7654
Mailing Address - Country:US
Mailing Address - Phone:385-434-4917
Mailing Address - Fax:
Practice Address - Street 1:1491 S 565 W
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-7654
Practice Address - Country:US
Practice Address - Phone:385-434-4917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician