Provider Demographics
NPI:1407848773
Name:GRIM, VIRGINIA S (AUD)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:S
Last Name:GRIM
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 S LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:KUTZTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19530-1509
Mailing Address - Country:US
Mailing Address - Phone:610-683-6108
Mailing Address - Fax:610-683-6108
Practice Address - Street 1:114 S LAUREL ST
Practice Address - Street 2:
Practice Address - City:KUTZTOWN
Practice Address - State:PA
Practice Address - Zip Code:19530-1509
Practice Address - Country:US
Practice Address - Phone:610-683-6108
Practice Address - Fax:610-683-6108
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT000006 L231H00000X
PAAT000006L237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1503917Medicaid
PAGR207309Medicare ID - Type Unspecified
PA1503917Medicaid