Provider Demographics
NPI:1699109231
Name:GRISHAM, LAURIE ANNE LEE
Entity type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:ANNE LEE
Last Name:GRISHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LAURIE
Other - Middle Name:ANNE LEE
Other - Last Name:WEILBACKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:368 FELL ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-5144
Mailing Address - Country:US
Mailing Address - Phone:415-861-0828
Mailing Address - Fax:415-861-0257
Practice Address - Street 1:1100 LINCOLN AVE STE 206
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-4956
Practice Address - Country:US
Practice Address - Phone:707-255-3716
Practice Address - Fax:707-255-3715
Is Sole Proprietor?:No
Enumeration Date:2013-08-31
Last Update Date:2013-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator