Provider Demographics
NPI:1225571987
Name:CIMINO, GRACE ANNE (MS)
Entity Type:Individual
Prefix:MS
First Name:GRACE
Middle Name:ANNE
Last Name:CIMINO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15505 LILAC DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-0003
Mailing Address - Country:US
Mailing Address - Phone:507-382-6275
Mailing Address - Fax:
Practice Address - Street 1:10077 DOGWOOD ST NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55448-5286
Practice Address - Country:US
Practice Address - Phone:763-755-3801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN01647101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional