Provider Demographics
NPI:1922404466
Name:GRIMES, JESSICA T (MS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:T
Last Name:GRIMES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 INDEPENDENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-1094
Mailing Address - Country:US
Mailing Address - Phone:856-210-2777
Mailing Address - Fax:609-228-0678
Practice Address - Street 1:401 INDEPENDENCE BLVD
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-1094
Practice Address - Country:US
Practice Address - Phone:856-210-2777
Practice Address - Fax:609-228-0678
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-11
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00695600235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist