Provider Demographics
NPI:1669790432
Name:ASMUSSEN, LEA ROSE (MS, LMFT)
Entity type:Individual
Prefix:MRS
First Name:LEA
Middle Name:ROSE
Last Name:ASMUSSEN
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22426 SAINT FRANCIS BLVD
Mailing Address - Street 2:
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-9670
Mailing Address - Country:US
Mailing Address - Phone:763-753-2500
Mailing Address - Fax:763-753-2500
Practice Address - Street 1:22426 SAINT FRANCIS BLVD
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-9670
Practice Address - Country:US
Practice Address - Phone:763-753-2500
Practice Address - Fax:763-753-2500
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1723106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist