Healthcare Provider Details

I. General information

NPI: 1811219504
Provider Name (Legal Business Name): LINDA A RASMUSSEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2010
Last Update Date: 02/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

193 E NEW FIELD DR
WASILLA AK
99654-1416
US

IV. Provider business mailing address

PO BOX 873103
WASILLA AK
99687-3103
US

V. Phone/Fax

Practice location:
  • Phone: 907-775-8742
  • Fax: 907-775-8742
Mailing address:
  • Phone: 907-373-6642
  • Fax: 907-373-6642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW S 814
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: