Provider Demographics
NPI:1427081371
Name:RASMUSSEN, WADE ALFRED (MA, LPC)
Entity type:Individual
Prefix:MR
First Name:WADE
Middle Name:ALFRED
Last Name:RASMUSSEN
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 PRENTICE ST N
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-1162
Mailing Address - Country:US
Mailing Address - Phone:715-344-4611
Mailing Address - Fax:
Practice Address - Street 1:209 PRENTICE ST N
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-1162
Practice Address - Country:US
Practice Address - Phone:715-344-4611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3435-125101YP2500X
WI3435104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI103508OtherSECURITY HEALTH PLAN