Provider Demographics
NPI:1124666292
Name:RASMUSSEN, NICOLAS (MS CCC-SLP TSSLD)
Entity type:Individual
Prefix:
First Name:NICOLAS
Middle Name:
Last Name:RASMUSSEN
Suffix:
Gender:U
Credentials:MS CCC-SLP TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 NOEL AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-6415
Mailing Address - Country:US
Mailing Address - Phone:347-682-6512
Mailing Address - Fax:
Practice Address - Street 1:52 NOEL AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-6415
Practice Address - Country:US
Practice Address - Phone:347-682-6512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-19
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist