Healthcare Provider Details

I. General information

NPI: 1487176798
Provider Name (Legal Business Name): ABIGAIL KATHERINE GRILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2017
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 KERRY ST STE 200
LANSING MI
48912-3671
US

IV. Provider business mailing address

300 BAILEY ST STE 2
EAST LANSING MI
48823-4688
US

V. Phone/Fax

Practice location:
  • Phone: 517-273-2706
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801101487
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: