Provider Demographics
NPI:1073399952
Name:GRIMM, TYLER MICHAEL (LMSW)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:MICHAEL
Last Name:GRIMM
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 1:3412 CENTER POINT RD NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5575
Mailing Address - Country:US
Mailing Address - Phone:319-382-8660
Mailing Address - Fax:
Practice Address - Street 1:600 STATE ST
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-3344
Practice Address - Country:US
Practice Address - Phone:319-382-8660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2024-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA118412104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker