Andrea Grimm, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

15164 Issued in TX

Practice address

1120 N New Rd
Waco, TX 76710-4860

Phone

(254) 776-1704

NPI assigned

Dec 17, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1639699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639699200000",
    "number": "1114687142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 FRANKLIN AVE",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767012111",
            "telephone_number": "254-755-9569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 N NEW RD",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767104860",
            "telephone_number": "254-776-1704"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2015 Alexander Ave",
            "address_purpose": "LOCATION",
            "city": "Waco",
            "state": "TX",
            "postal_code": "767082821",
            "country_code": "US",
            "telephone_number": "254-753-2900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRIMM",
        "first_name": "ANDREA",
        "credential": "CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-17",
        "last_updated": "2021-12-17",
        "certification_date": "2021-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TX",
            "license": "15164",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0658338-01",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Clara Dutton Griffey, DDS
• Jared Blake Griffin, NNP-BC
• Jackson O Griggs, MD
• Amy Grigsby
• Alyssa Cheyenne Grimm, SLP-ASSISTANT
• Hayden Joe Grimm, PTA
• Gayla Kay Grisham, LBSW
• GTG Enterprises, LLC
• Veronica Guardiola, OT
• Brandi Guel

• Speech-Language Pathologist in Waco, TX
• Providers in Waco, TX by specialty
• Speech-Language Pathologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.