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General NPI Number Information
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NPI Number | 1760028880
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Entity Type | Individual
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Provider Name | KATHRYN GRIMES
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Gender | Female
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Dates
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Enumeration Date | 11/24/2019
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Last Update Date | 04/18/2025
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Provider Practice Location Address
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Address Line | 1711 S NEIL ST STE 2
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City | CHAMPAIGN
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State | IL
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Zip | 61820-7262
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Country | US
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Telephone | 872-256-8818
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Fax |
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Provider Business Mailing Address
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Address Line | 2816 N 1100 EAST RD
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City | MANSFIELD
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State | IL
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Zip | 61854-6857
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Country | US
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Telephone | 815-383-7461
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 150104071
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License Number State | IL
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