Healthcare Provider Details

I. General information

NPI: 1043651649
Provider Name (Legal Business Name): JANELLE M KASSIEN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2013
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 68TH ST SE
GRAND RAPIDS MI
49548-6927
US

IV. Provider business mailing address

11165 THOMAS AVE NW
GRAND RAPIDS MI
49534-6712
US

V. Phone/Fax

Practice location:
  • Phone: 616-445-5000
  • Fax:
Mailing address:
  • Phone: 231-881-0375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801089326
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: