Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 4890 | WI |
NPI | 1003579988 |
---|---|
Provider Name | Samina L Grimes |
First Address | La Crosse, WI 54603-1925 |
Second Address | La Crosse, WI 54603-1925 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2021 |
Last Update Date | 18/10/2021 |