Provider Demographics
NPI:1235111634
Name:GRIPSHOVER, DANIEL L (CP)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:L
Last Name:GRIPSHOVER
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17277
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41017-0277
Mailing Address - Country:US
Mailing Address - Phone:859-426-7800
Mailing Address - Fax:
Practice Address - Street 1:503 CENTRE VIEW BLVD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-3444
Practice Address - Country:US
Practice Address - Phone:859-426-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1153103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY89000640Medicaid
KYCK6701OtherRAILROAD MEDICARE
KY000000249594OtherANTHEM
KY294319000OtherMAGELLAN
KY680015873OtherMEDICARE RAILROAD
KY1199659OtherCHA
KY294319000OtherMAGELLAN
KY1199659OtherCHA