Healthcare Provider Details

I. General information

NPI: 1295578003
Provider Name (Legal Business Name): ASHLYN GRACE RASMUSSEN AAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 W MAIN ST
EVERSON WA
98247-8217
US

IV. Provider business mailing address

1700 KAMM RD
LYNDEN WA
98264-9540
US

V. Phone/Fax

Practice location:
  • Phone: 360-788-4228
  • Fax:
Mailing address:
  • Phone: 360-746-9418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: