Provider Demographics
NPI:1740849413
Name:RASMUSSEN, MICHAELA DANIELLE (AUD CCC-A)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:DANIELLE
Last Name:RASMUSSEN
Suffix:
Gender:F
Credentials:AUD CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8806 S REDWOOD RD STE 103
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-9338
Mailing Address - Country:US
Mailing Address - Phone:801-495-4800
Mailing Address - Fax:
Practice Address - Street 1:756 E 12200 S
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9724
Practice Address - Country:US
Practice Address - Phone:801-495-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT112873094101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist