Provider Demographics
NPI:1407418890
Name:GRIM, PATRICIA ELIZABETH
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ELIZABETH
Last Name:GRIM
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 1:1201 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-4301
Mailing Address - Country:US
Mailing Address - Phone:855-581-0100
Mailing Address - Fax:
Practice Address - Street 1:1201 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-4301
Practice Address - Country:US
Practice Address - Phone:855-581-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician