Provider Demographics
NPI:1801198882
Name:GRIMES-PICARAZZI, LINDA (CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:
Last Name:GRIMES-PICARAZZI
Suffix:
Gender:F
Credentials:CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 RUPERT RD
Mailing Address - Street 2:
Mailing Address - City:SELKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:12158-2118
Mailing Address - Country:US
Mailing Address - Phone:518-767-2580
Mailing Address - Fax:
Practice Address - Street 1:700 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-2436
Practice Address - Country:US
Practice Address - Phone:518-439-8886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-24
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008560-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist