Healthcare Provider Details

I. General information

NPI: 1134752108
Provider Name (Legal Business Name): BRYCE ALLEN GRINDSTAFF LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2020
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 CLEVELAND AVE NW
CANTON OH
44702-1805
US

IV. Provider business mailing address

625 CLEVELAND AVE NW
CANTON OH
44702-1805
US

V. Phone/Fax

Practice location:
  • Phone: 330-445-2677
  • Fax: 330-455-2101
Mailing address:
  • Phone: 330-455-0374
  • Fax: 330-453-6716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS2005696
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: