Healthcare Provider Details

I. General information

NPI: 1053991786
Provider Name (Legal Business Name): CASSIE HALL LMSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 HALL ST SW STE 112E
GRAND RAPIDS MI
49503-6500
US

IV. Provider business mailing address

401 HALL ST SW STE 112E
GRAND RAPIDS MI
49503-6500
US

V. Phone/Fax

Practice location:
  • Phone: 616-275-4846
  • Fax:
Mailing address:
  • Phone: 616-275-4846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801117679
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851114159
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: