Provider Demographics
NPI:1962171801
Name:GRINDER, CYNTHIA A (LMSW)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:A
Last Name:GRINDER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 W EDWARDS AVE
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-2821
Mailing Address - Country:US
Mailing Address - Phone:208-409-4274
Mailing Address - Fax:
Practice Address - Street 1:420 W EDWARDS AVE
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-2821
Practice Address - Country:US
Practice Address - Phone:208-409-4274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW34432104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker