Provider Demographics
NPI:1154646347
Name:GRIMES, NICOLA MARIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:NICOLA
Middle Name:MARIE
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 1:316 MORGAN LN
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:KY
Mailing Address - Zip Code:42376-9062
Mailing Address - Country:US
Mailing Address - Phone:270-733-3241
Mailing Address - Fax:
Practice Address - Street 1:2420 W 3RD ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-0328
Practice Address - Country:US
Practice Address - Phone:270-685-3141
Practice Address - Fax:270-684-4867
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY1900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist