Healthcare Provider Details

I. General information

NPI: 1851877443
Provider Name (Legal Business Name): LINDA LEE GRILL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3430 NEWBURG RD STE 210
LOUISVILLE KY
40218-2458
US

IV. Provider business mailing address

3401 DELL RD
LOUISVILLE KY
40299-3513
US

V. Phone/Fax

Practice location:
  • Phone: 502-454-8800
  • Fax: 502-736-0140
Mailing address:
  • Phone: 502-261-9460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3794
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: