Provider Demographics
NPI:1881062198
Name:GRIMMETT, NANCY
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:GRIMMETT
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 1:1520 DERHAKE RD
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-6416
Mailing Address - Country:US
Mailing Address - Phone:314-989-7304
Mailing Address - Fax:314-388-5751
Practice Address - Street 1:1520 DERHAKE RD
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-6416
Practice Address - Country:US
Practice Address - Phone:314-989-7304
Practice Address - Fax:314-388-5751
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0032721041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool