Provider Demographics
NPI:1144586462
Name:GRIMM, DONNA LEE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:LEE
Last Name:GRIMM
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 VESTRY CT
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835-1383
Mailing Address - Country:US
Mailing Address - Phone:530-518-4003
Mailing Address - Fax:916-928-9187
Practice Address - Street 1:3065 FREEPORT BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95818-4347
Practice Address - Country:US
Practice Address - Phone:530-518-4003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12148235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist