Provider Demographics
NPI:1659789931
Name:GRIMM, APRYLE
Entity Type:Individual
Prefix:
First Name:APRYLE
Middle Name:
Last Name:GRIMM
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 1:85 OLD EAGLE SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:STRAFFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19087-2556
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:85 OLD EAGLE SCHOOL RD
Practice Address - Street 2:
Practice Address - City:STRAFFORD
Practice Address - State:PA
Practice Address - Zip Code:19087-2556
Practice Address - Country:US
Practice Address - Phone:717-712-8965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-30
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA120156310103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA$$$$$$$$$OtherSOCIAL SECURITY