Provider Demographics
NPI:1629505268
Name:DEGRAAF, CASSANDRA MARIE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:MARIE
Last Name:DEGRAAF
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:MARIE
Other - Last Name:VISCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 68TH ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49548-6927
Mailing Address - Country:US
Mailing Address - Phone:616-455-5000
Mailing Address - Fax:
Practice Address - Street 1:1870 LEONARD ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-5650
Practice Address - Country:US
Practice Address - Phone:616-956-9619
Practice Address - Fax:616-956-8033
Is Sole Proprietor?:No
Enumeration Date:2017-05-14
Last Update Date:2020-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801102082104100000X
225400000X
MI68011067211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner