Provider Demographics
NPI:1861115883
Name:GRIMBALL, ANDREW (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:GRIMBALL
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 TENTH ST
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-4128
Mailing Address - Country:US
Mailing Address - Phone:931-201-9682
Mailing Address - Fax:
Practice Address - Street 1:94 TENTH ST
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-4128
Practice Address - Country:US
Practice Address - Phone:931-201-9682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7536235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist