Provider Demographics
NPI:1427106962
Name:GRIMM, JOHN E (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:GRIMM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20619 STRATFORD CIR
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44149-4985
Mailing Address - Country:US
Mailing Address - Phone:440-238-1534
Mailing Address - Fax:
Practice Address - Street 1:20619 STRATFORD CIR
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44149-4985
Practice Address - Country:US
Practice Address - Phone:440-238-1534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2024103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0372538Medicaid
OHGRCPO1821Medicare ID - Type Unspecified