Provider Demographics
NPI:1982253506
Name:RASMUSSEN, HEIDI (LCSW, ADC)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:RASMUSSEN
Suffix:
Gender:F
Credentials:LCSW, ADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 W CLARK ST
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83204-3141
Mailing Address - Country:US
Mailing Address - Phone:208-234-9361
Mailing Address - Fax:208-909-2662
Practice Address - Street 1:645 W CLARK ST
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83204-3141
Practice Address - Country:US
Practice Address - Phone:208-234-9361
Practice Address - Fax:208-909-2662
Is Sole Proprietor?:No
Enumeration Date:2019-09-06
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID11736101YA0400X
IDLMSW-38989104100000X
ID418371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1619090628OtherOPTUM
ID1619090628OtherAETNA FIRST HEALTH
ID1619090628OtherSELECTHEALTH
ID1619090628OtherIDAHO OPTUM
ID1619090628OtherAETNA
ID1619090628Medicaid
ID1619090628OtherPACIFIC SOURCE
ID1619090628OtherREGENCE
ID1619090628OtherBLUE CROSS OF IDAHO
ID1619090628OtherSELECT HEALTH