Provider Demographics
NPI:1912523093
Name:RASMUSSEN, MAKENZI TAYLOR (MSW)
Entity type:Individual
Prefix:
First Name:MAKENZI
Middle Name:TAYLOR
Last Name:RASMUSSEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1243 E WILSON ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-3759
Mailing Address - Country:US
Mailing Address - Phone:608-797-5661
Mailing Address - Fax:
Practice Address - Street 1:629 RIVER ST STE C
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53508-9189
Practice Address - Country:US
Practice Address - Phone:608-424-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health