Provider Demographics
NPI:1063563146
Name:RASMUSSEN, MICHELE L (MA, LPC)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:L
Last Name:RASMUSSEN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:HAYS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2831 POST RD STE 300
Mailing Address - Street 2:
Mailing Address - City:PLOVER
Mailing Address - State:WI
Mailing Address - Zip Code:54467-3415
Mailing Address - Country:US
Mailing Address - Phone:715-600-2798
Mailing Address - Fax:
Practice Address - Street 1:2831 POST RD STE 300
Practice Address - Street 2:
Practice Address - City:PLOVER
Practice Address - State:WI
Practice Address - Zip Code:54467-3415
Practice Address - Country:US
Practice Address - Phone:715-600-2798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3540-125101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40988300Medicaid