Individual provider Active NPI

Tessa Marie Rasmussen, SLP

  • Speech-Language Pathologist
  • Fargo, ND
National Provider Identifier
1609368844
Registry record updated Dec 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
1649 Issued in ND
Practice address
4500 36TH Ave S Ste 200
Fargo, ND 58104-5275
Phone
(701) 532-1507
Fax
(701) 532-1529
NPI assigned
Jun 4, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 1649 ND Primary

Addresses

Primary practice location

4500 36TH Ave S Ste 200
Fargo, ND 58104-5275

Mailing address

1411 32ND St S
Fargo, ND 58103-6304
Phone (701) 532-1507

Other identifiers 1

IdentifierTypeStateIssuer
1476357MedicaidND

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190426001712 ND Practitioner - Qualified Speech Language Pathologist 7416299227 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1649NDMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
On Spot Therapy and Orofacial Myology, LLC Speech-Language Pathologist CurrentSince Dec 28, 2019 Accepting new patients

Locations

1411 32nd St SW
Fargo, ND 58103
Phone (701) 232-1232

4500 36th Ave S
Ste 200
Fargo, ND 58104
Phone (701) 532-1507

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1528070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608249600000",
    "number": "1609368844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1411 32ND ST S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581036304",
            "telephone_number": "701-532-1507",
            "fax_number": "701-532-1529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 36TH AVE S STE 200",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581045275",
            "telephone_number": "701-532-1507",
            "fax_number": "701-532-1529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RASMUSSEN",
        "first_name": "TESSA",
        "middle_name": "MARIE",
        "credential": "SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-04",
        "last_updated": "2020-12-18",
        "certification_date": "2020-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "ND",
            "license": "1649",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1476357",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.