Provider Demographics
NPI:1538412242
Name:RASMUSSEN, KIRSTEN HOLLY (LCSW, CADC)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:HOLLY
Last Name:RASMUSSEN
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 N. 085 WILD ROSE ROAD
Mailing Address - Street 2:
Mailing Address - City:ST. CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174
Mailing Address - Country:US
Mailing Address - Phone:630-715-4006
Mailing Address - Fax:
Practice Address - Street 1:29W120 BUTTERFIELD ROAD
Practice Address - Street 2:SUITE 104 A
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555
Practice Address - Country:US
Practice Address - Phone:630-715-4006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0153541041C0700X
NCC0132451041C0700X
IL24479411041S0200X
COCSW.099298231041C0700X
IL29471101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)