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General NPI Number Information
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NPI Number | 1457177586
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Entity Type | Individual
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Provider Name | JERROD GRIMM
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Gender | Male
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Dates
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Enumeration Date | 11/22/2024
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 525 METRO PL N STE 300
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City | DUBLIN
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State | OH
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Zip | 43017-5320
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Country | US
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Telephone | 855-289-1722
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Fax |
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Provider Business Mailing Address
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Address Line | 820 N 3RD ST APT 1
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City | DENNISON
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State | OH
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Zip | 44621-1056
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Country | US
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Telephone | 440-260-6835
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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