MEDICARE: MRS. CORDELIA GRIMES LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	149.020285	IL

General Provider Information

NPI Number	:	1083102578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CORDELIA GRIMES LCSW

Provider Business Mailing Address
First Line	:	832 BENNINGTON DR
Second Line	:
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-8841
Country	:	US
Telephone Number	:	847-852-6372
Fax Number	:

Provider Business Practice Location Address
First Line	:	4305 N LINCOLN AVE STE G
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-1807
Country	:	US
Telephone Number	:	815-216-4116
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2018
Last Update Date	:	06/22/2022

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