Provider Demographics
NPI:1093263659
Name:GRIMM, ALLISON (LCSW)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:GRIMM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 COUNTRY LAKES DR
Mailing Address - Street 2:APT 208
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-9037
Mailing Address - Country:US
Mailing Address - Phone:309-712-9463
Mailing Address - Fax:
Practice Address - Street 1:75 EXECUTIVE DR
Practice Address - Street 2:#401E
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-8137
Practice Address - Country:US
Practice Address - Phone:331-444-3618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0186421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical