Provider Demographics
NPI:1578161402
Name:GRIGGS, YAVONNIE LESLIE
Entity Type:Individual
Prefix:
First Name:YAVONNIE
Middle Name:LESLIE
Last Name:GRIGGS
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 1:273 OYLER RD
Mailing Address - Street 2:
Mailing Address - City:ETHEL
Mailing Address - State:WA
Mailing Address - Zip Code:98542-9708
Mailing Address - Country:US
Mailing Address - Phone:903-486-1011
Mailing Address - Fax:
Practice Address - Street 1:3285 FERGUSON LN SW, TUMWATER, WA 98512
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512
Practice Address - Country:US
Practice Address - Phone:360-943-1907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist