Healthcare Provider Details

I. General information

NPI: 1083014195
Provider Name (Legal Business Name): KAREN GRIMLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2014
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 EAST COUNTY LINE ROAD STE C-1
INDIANAPOLIS IN
46227-6291
US

IV. Provider business mailing address

6626 E 75TH STREET STE 500
INDIANAPOLIS IN
46250-2890
US

V. Phone/Fax

Practice location:
  • Phone: 317-497-6290
  • Fax: 317-497-6290
Mailing address:
  • Phone: 317-621-7561
  • Fax: 317-355-6096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34006611A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: