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NPI Code Detail

MEDICARE: MS. MICHELLE JENSEN RAS

MEDICARE: MS. MICHELLE JENSEN RAS
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
1101YA0400XAddiction (Substance Use Disorder) CounselorRAS J0501120759

General Provider Information

NPI Number : 1538289814
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MICHELLE JENSEN RAS
Provider Business Mailing Address
First Line : 973 STONY POINT RD
Second Line :
City : SANTA ROSA
State : CA
Zip : 95407-7129
Country : US
Telephone Number : 707-528-0387
Fax Number :
Provider Business Practice Location Address
First Line : 1901 CLEVELAND AVE
Second Line : SUITE B
City : SANTA ROSA
State : CA
Zip : 95401-4282
Country : US
Telephone Number : 707-576-0818
Fax Number : 707-576-7845
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2007
Last Update Date : 07/08/2007

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