Provider Demographics
NPI:1801226188
Name:GRIGSBY, KRISTAL (LICSW)
Entity Type:Individual
Prefix:
First Name:KRISTAL
Middle Name:
Last Name:GRIGSBY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 4TH AVE W
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-1220
Mailing Address - Country:US
Mailing Address - Phone:952-496-8565
Mailing Address - Fax:952-496-8355
Practice Address - Street 1:1216 RYANS RD
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:MN
Practice Address - Zip Code:56187-1722
Practice Address - Country:US
Practice Address - Phone:507-372-2921
Practice Address - Fax:507-372-5789
Is Sole Proprietor?:No
Enumeration Date:2013-11-22
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN206171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical