Provider Demographics
NPI:1124326913
Name:GRIMES, JENNIFER ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANN
Last Name:GRIMES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:GRIMES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2062 JOHN JONES RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-9707
Mailing Address - Country:US
Mailing Address - Phone:530-758-3114
Mailing Address - Fax:707-429-5358
Practice Address - Street 1:2062 JOHN JONES RD
Practice Address - Street 2:SUITE 210
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-9707
Practice Address - Country:US
Practice Address - Phone:530-758-3114
Practice Address - Fax:707-429-5358
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALEP2309103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist