Healthcare Provider Details

I. General information

NPI: 1144124587
Provider Name (Legal Business Name): ELAINE SUZZANNE GRIMWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELLIE GRIMWOOD

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 N 26TH ST
SAINT JOSEPH MO
64506-2748
US

IV. Provider business mailing address

3307 WESTWOOD DR
SAINT JOSEPH MO
64505-1500
US

V. Phone/Fax

Practice location:
  • Phone: 816-671-4004
  • Fax:
Mailing address:
  • Phone: 816-351-3161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number2026046139
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: