Provider Demographics
NPI:1639846694
Name:GRIMWOOD, HALEY N (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:N
Last Name:GRIMWOOD
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:OH
Mailing Address - Zip Code:44425-1713
Mailing Address - Country:US
Mailing Address - Phone:330-984-8378
Mailing Address - Fax:
Practice Address - Street 1:240 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:HUBBARD
Practice Address - State:OH
Practice Address - Zip Code:44425-1713
Practice Address - Country:US
Practice Address - Phone:330-984-8378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.09299133V00000X
PADN007327133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered