Provider Demographics
NPI:1336350578
Name:GRIGSON, GENA (MSW)
Entity Type:Individual
Prefix:MRS
First Name:GENA
Middle Name:
Last Name:GRIGSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 ANDERSON RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CRESCENT SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-1521
Mailing Address - Country:US
Mailing Address - Phone:859-344-9321
Mailing Address - Fax:859-344-0731
Practice Address - Street 1:2521 ANDERSON RD
Practice Address - Street 2:SUITE A
Practice Address - City:CRESCENT SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:41017-1521
Practice Address - Country:US
Practice Address - Phone:859-344-9321
Practice Address - Fax:859-344-0731
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-26
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00097551041C0700X
KYKY-20101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK147190Medicare PIN
OHGRSW28422Medicare PIN