Healthcare Provider Details

I. General information

NPI: 1629982160
Provider Name (Legal Business Name): CASSIDY ELLEN PIFER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 FULTON ST E STE 222
GRAND RAPIDS MI
49503-3262
US

IV. Provider business mailing address

7255 BITTERSWEET CT
ALLENDALE MI
49401-9646
US

V. Phone/Fax

Practice location:
  • Phone: 616-490-3468
  • Fax:
Mailing address:
  • Phone: 616-581-9461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6851117762
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: