Provider Demographics
NPI:1669877643
Name:GRIMMER, NANCY (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:GRIMMER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5881 SHADOW GLEN DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-5406
Mailing Address - Country:US
Mailing Address - Phone:530-209-1030
Mailing Address - Fax:530-232-0132
Practice Address - Street 1:5881 SHADOW GLEN DR
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-5406
Practice Address - Country:US
Practice Address - Phone:530-209-1030
Practice Address - Fax:530-232-0132
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-03
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP19758235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASP19758OtherSPEECH AND LANGUAGE PATHOLOGIST