MEDICARE: CASSIDY VANMALSEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	6851119718	MI

General Provider Information

NPI Number	:	1083585632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSIDY VANMALSEN

Provider Business Mailing Address
First Line	:	321 LORENE ST
Second Line	:
City	:	WAYLAND
State	:	MI
Zip	:	49348-1125
Country	:	US
Telephone Number	:	269-967-3473
Fax Number	:

Provider Business Practice Location Address
First Line	:	3980 CHICAGO DR SW STE 140
Second Line	:
City	:	GRANDVILLE
State	:	MI
Zip	:	49418-1392
Country	:	US
Telephone Number	:	616-209-9295
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2025
Last Update Date	:	09/16/2025

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Directions to “ CASSIDY VANMALSEN ” Practice Location

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