Healthcare Provider Details

I. General information

NPI: 1356253983
Provider Name (Legal Business Name): CHEYENNE GRIM
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35280 FLORENCE ST
WESTLAND MI
48185-3609
US

IV. Provider business mailing address

35280 FLORENCE ST
WESTLAND MI
48185-3609
US

V. Phone/Fax

Practice location:
  • Phone: 734-674-0689
  • Fax:
Mailing address:
  • Phone: 734-674-0689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7152001549
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: