Healthcare Provider Details

I. General information

NPI: 1487590386
Provider Name (Legal Business Name): ASHLEY GRACE GRIMM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 4TH AVE
GRINNELL IA
50112-2042
US

IV. Provider business mailing address

814 4TH AVE
GRINNELL IA
50112-2041
US

V. Phone/Fax

Practice location:
  • Phone: 641-323-2729
  • Fax:
Mailing address:
  • Phone: 319-440-0446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number136264
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: