Provider Demographics
NPI:1083339063
Name:GRIMES, CINDY KAYE (MS CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:KAYE
Last Name:GRIMES
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23395 BURRELL WINGATE RD
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77705-9182
Mailing Address - Country:US
Mailing Address - Phone:409-794-1412
Mailing Address - Fax:
Practice Address - Street 1:23395 BURRELL WINGATE RD
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77705-9182
Practice Address - Country:US
Practice Address - Phone:409-794-1412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16686235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist