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General NPI Number Information
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NPI Number | 1144586462
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Entity Type | Individual
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Provider Name | DONNA LEE GRIMM M.A., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 04/11/2012
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Last Update Date | 04/11/2012
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Provider Practice Location Address
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Address Line | 3065 FREEPORT BLVD
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City | SACRAMENTO
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State | CA
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Zip | 95818-4347
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Country | US
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Telephone | 530-518-4003
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Fax |
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Provider Business Mailing Address
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Address Line | 28 VESTRY CT
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City | SACRAMENTO
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State | CA
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Zip | 95835-1383
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Country | US
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Telephone | 530-518-4003
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Fax | 916-928-9187
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 12148
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License Number State | CA
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