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NPI Code Detail

MEDICARE: MRS. KHRISTINE JOY GRIDLEY BS

MEDICARE: MRS. KHRISTINE JOY GRIDLEY BS
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1366586000
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KHRISTINE JOY GRIDLEY BS
Provider Business Mailing Address
First Line : 2129 HEAL RD
Second Line :
City : MALTA
State : IL
Zip : 60150-8546
Country : US
Telephone Number : 815-825-2383
Fax Number :
Provider Business Practice Location Address
First Line : 1321 N 7TH ST
Second Line :
City : ROCHELLE
State : IL
Zip : 61068-1185
Country : US
Telephone Number : 815-562-3801
Fax Number : 815-562-4481
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2007
Last Update Date : 07/08/2007

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