MEDICARE: DR. DAVID GRANT RASMUSSEN PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	1266	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	6705900	OTHER	WA	PREMERA
3	11608357	OTHER	WA	CAQH AETNA

General Provider Information

NPI Number	:	1699830364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID GRANT RASMUSSEN PSY.D.

Provider Business Mailing Address
First Line	:	16030 BOTHELL EVERETT HWY
Second Line	:	SUITE 295
City	:	MILL CREEK
State	:	WA
Zip	:	98012-1741
Country	:	US
Telephone Number	:	425-337-7133
Fax Number	:

Provider Business Practice Location Address
First Line	:	16030 BOTHELL EVERETT HWY
Second Line	:	SUITE 295
City	:	MILL CREEK
State	:	WA
Zip	:	98012-1741
Country	:	US
Telephone Number	:	425-337-7133
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2006
Last Update Date	:	07/08/2007

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