Healthcare Provider Details

I. General information

NPI: 1861971277
Provider Name (Legal Business Name): ANNA GRIMMETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W PARK
LIVINGSTON TX
77351-8151
US

IV. Provider business mailing address

746 E LAKE DR
LIVINGSTON TX
77351-6017
US

V. Phone/Fax

Practice location:
  • Phone: 936-328-5021
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number111450
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: