Provider Demographics
NPI:1992054316
Name:GRIGSBY, JANDA ANITA (MA)
Entity type:Individual
Prefix:
First Name:JANDA
Middle Name:ANITA
Last Name:GRIGSBY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 LIBERTY ST NE STE 2
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2463
Mailing Address - Country:US
Mailing Address - Phone:541-740-6589
Mailing Address - Fax:503-589-3179
Practice Address - Street 1:1229 MAIN STREET
Practice Address - Street 2:
Practice Address - City:PHILOMATH
Practice Address - State:OR
Practice Address - Zip Code:97370
Practice Address - Country:US
Practice Address - Phone:541-740-6589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health