Healthcare Provider Details

I. General information

NPI: 1992054316
Provider Name (Legal Business Name): JANDA ANITA GRIGSBY MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2012
Last Update Date: 10/08/2021
Certification Date: 09/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 MAIN STREET
PHILOMATH OR
97370
US

IV. Provider business mailing address

805 LIBERTY ST NE STE 2
SALEM OR
97301-2463
US

V. Phone/Fax

Practice location:
  • Phone: 541-740-6589
  • Fax:
Mailing address:
  • Phone: 541-740-6589
  • Fax: 503-589-3179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: