Provider Demographics
NPI:1033241948
Name:GRIMES, LINDA THRESHER (SLP)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:THRESHER
Last Name:GRIMES
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3274 S NACO HWY
Mailing Address - Street 2:
Mailing Address - City:BISBEE
Mailing Address - State:AZ
Mailing Address - Zip Code:85603-6344
Mailing Address - Country:US
Mailing Address - Phone:802-839-9890
Mailing Address - Fax:520-515-2985
Practice Address - Street 1:3274 S NACO HWY
Practice Address - Street 2:
Practice Address - City:BISBEE
Practice Address - State:AZ
Practice Address - Zip Code:85603-6344
Practice Address - Country:US
Practice Address - Phone:802-839-9890
Practice Address - Fax:520-515-2985
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPL5408235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist