Healthcare Provider Details

I. General information

NPI: 1447772157
Provider Name (Legal Business Name): VICTORIA M GRIMM BSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2017
Last Update Date: 07/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 VARTAN WAY STE 204
HARRISBURG PA
17110-9763
US

IV. Provider business mailing address

PO BOX 597
MOUNTVILLE PA
17554-0597
US

V. Phone/Fax

Practice location:
  • Phone: 717-920-9434
  • Fax: 717-920-9197
Mailing address:
  • Phone: 717-285-7121
  • Fax: 717-285-5302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH003487
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: