Healthcare Provider Details

I. General information

NPI: 1578414850
Provider Name (Legal Business Name): RADICAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2026
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MONROE AVE NW STE 314
GRAND RAPIDS MI
49503-1451
US

IV. Provider business mailing address

800 MONROE AVE NW STE 314
GRAND RAPIDS MI
49503-1451
US

V. Phone/Fax

Practice location:
  • Phone: 616-481-1479
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: RACHEL DZIABUDA
Title or Position: OWNER
Credential: LMSW
Phone: 616-481-1479