Provider Demographics
NPI:1982106852
Name:RASMUSSEN, JOAN C (LCSW)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:C
Last Name:RASMUSSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:669 S APPALOOSA CIR
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:UT
Mailing Address - Zip Code:84340-9629
Mailing Address - Country:US
Mailing Address - Phone:801-588-9538
Mailing Address - Fax:
Practice Address - Street 1:111 E FOREST ST STE H
Practice Address - Street 2:
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302-2127
Practice Address - Country:US
Practice Address - Phone:801-588-9538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-06
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10895071-35011041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT108950713503OtherSOCIAL SERVICE WORKER