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General NPI Number Information
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NPI Number | 1396211967
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Entity Type | Individual
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Provider Name | BRENDA MARIE GRIGSBY
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Gender | Female
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Dates
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Enumeration Date | 10/22/2018
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Last Update Date | 10/22/2018
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Provider Practice Location Address
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Address Line | 8016 STATE LINE RD STE 205
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City | PRAIRIE VILLAGE
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State | KS
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Zip | 66208-3713
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Country | US
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Telephone | 913-652-6668
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Fax | 913-652-6698
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Provider Business Mailing Address
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Address Line | 2290 W JOHNSTON ST
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City | OLATHE
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State | KS
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Zip | 66061-6864
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Country | US
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Telephone | 402-720-6443
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 4794
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License Number State | KS
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