Individual
HEIDI RASMUSSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, ADC
Contact information
Practice address
645 W CLARK ST, POCATELLO, ID 83204-3141
(208) 234-9361
(208) 909-2662
Mailing address
645 W CLARK ST, POCATELLO, ID 83204-3141
(208) 234-9361
(208) 909-2662
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
11736
ID
104100000X
Social Worker
LMSW-38989
ID
1041C0700X
Clinical Social Worker
Primary
41837
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1619090628
OPTUM
ID
05
—
1619090628
—
ID
Enumeration date
09/06/2019
Last updated
06/03/2024
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