Provider Demographics
NPI:1770732521
Name:GRIMES, STACEY D
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:D
Last Name:GRIMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 1ST ST N
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-8608
Mailing Address - Country:US
Mailing Address - Phone:205-621-8900
Mailing Address - Fax:205-621-7169
Practice Address - Street 1:1010 1ST ST N
Practice Address - Street 2:SUITE 301
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8608
Practice Address - Country:US
Practice Address - Phone:205-621-8900
Practice Address - Fax:205-621-7169
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL892A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist