Provider Demographics
NPI:1083488860
Name:GRINDLE, NIKKI KAE (LMSW)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:KAE
Last Name:GRINDLE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3044 14 MILE RD NE
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:MI
Mailing Address - Zip Code:49345-9515
Mailing Address - Country:US
Mailing Address - Phone:616-799-9177
Mailing Address - Fax:
Practice Address - Street 1:3044 14 MILE RD NE
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:MI
Practice Address - Zip Code:49345-9515
Practice Address - Country:US
Practice Address - Phone:616-799-9177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801098499104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker