Healthcare Provider Details

I. General information

NPI: 1114582285
Provider Name (Legal Business Name): ELIZABETH A RASMUSSEN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH A SMITH MSW

II. Dates (important events)

Enumeration Date: 05/04/2019
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 BLUE STAR HWY
SOUTH HAVEN MI
49090-7758
US

IV. Provider business mailing address

930 BLUE STAR HWY
SOUTH HAVEN MI
49090-7758
US

V. Phone/Fax

Practice location:
  • Phone: 269-637-1115
  • Fax:
Mailing address:
  • Phone: 269-637-1115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: