Provider Demographics
NPI:1780489054
Name:ELLIS-KESSLER, CASSANDRA N (CHW)
Entity type:Individual
Prefix:MISS
First Name:CASSANDRA
Middle Name:N
Last Name:ELLIS-KESSLER
Suffix:
Gender:
Credentials:CHW
Other - Prefix:MISS
Other - First Name:CASSANDRA
Other - Middle Name:N
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1011 2ND ST RM 204
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49440-1231
Mailing Address - Country:US
Mailing Address - Phone:231-733-8612
Mailing Address - Fax:
Practice Address - Street 1:1011 2ND ST RM 204
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49440-1231
Practice Address - Country:US
Practice Address - Phone:231-733-8612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker