Provider Demographics
NPI:1992984058
Name:REIFFER, MICHAEL JACK (LMSW)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JACK
Last Name:REIFFER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9090 S RODGERS CT SE
Mailing Address - Street 2:SUITE D
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316-8052
Mailing Address - Country:US
Mailing Address - Phone:616-891-8770
Mailing Address - Fax:
Practice Address - Street 1:9090 S RODGERS CT SE
Practice Address - Street 2:SUITE D
Practice Address - City:CALEDONIA
Practice Address - State:MI
Practice Address - Zip Code:49316-8052
Practice Address - Country:US
Practice Address - Phone:616-891-8770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010863121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical