Provider Demographics
NPI:1770805822
Name:GRIMM, JENNIFER HOWARD (MSW)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:HOWARD
Last Name:GRIMM
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:JOAN
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1074 MORNINGVIEW DR
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-1162
Mailing Address - Country:US
Mailing Address - Phone:330-630-1309
Mailing Address - Fax:
Practice Address - Street 1:1074 MORNINGVIEW DR
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-1162
Practice Address - Country:US
Practice Address - Phone:330-630-1309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0025648104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker