Provider Demographics
NPI:1396211967
Name:GRIGSBY, BRENDA MARIE
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:MARIE
Last Name:GRIGSBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2290 W JOHNSTON ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-6864
Mailing Address - Country:US
Mailing Address - Phone:402-720-6443
Mailing Address - Fax:
Practice Address - Street 1:8016 STATE LINE RD STE 205
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-3713
Practice Address - Country:US
Practice Address - Phone:913-652-6668
Practice Address - Fax:913-652-6698
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS47941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical