Provider Demographics
NPI:1710480421
Name:RASMUSSEN, SHANLEYE (BCBA)
Entity type:Individual
Prefix:
First Name:SHANLEYE
Middle Name:
Last Name:RASMUSSEN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5055 E BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3640
Mailing Address - Country:US
Mailing Address - Phone:602-888-8882
Mailing Address - Fax:
Practice Address - Street 1:5055 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3640
Practice Address - Country:US
Practice Address - Phone:602-888-8882
Practice Address - Fax:855-859-1671
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106E00000X
GA1-20-43674103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst