Provider Demographics
NPI:1083428759
Name:GRINDSTAFF, EMMA MAE
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:MAE
Last Name:GRINDSTAFF
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 BUSH ST
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:MI
Mailing Address - Zip Code:48451-9047
Mailing Address - Country:US
Mailing Address - Phone:810-522-0872
Mailing Address - Fax:
Practice Address - Street 1:1402 S SAGINAW ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-3705
Practice Address - Country:US
Practice Address - Phone:810-496-5553
Practice Address - Fax:810-257-3755
Is Sole Proprietor?:No
Enumeration Date:2025-02-04
Last Update Date:2025-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician