Jeanette Grissom

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

39000273A Issued in IN

Practice address

6950 Hillsdale CT
Indianapolis, IN 46250-2040

Phone

(317) 621-7740

Fax

(317) 621-7608

NPI assigned

Jun 30, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: jgrissom169382@ecommunitydirect.com

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

{
    "created_epoch": "1435622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604880000000",
    "number": "1790168599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6626 W 75TH STREET",
            "address_2": "STE 500",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462502890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6950 HILLSDALE CT",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462502040",
            "telephone_number": "317-621-7740",
            "fax_number": "317-621-7608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRISSOM",
        "first_name": "JEANETTE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-06-30",
        "last_updated": "2020-11-09",
        "certification_date": "2020-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IN",
            "license": "87000380A",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "39000273A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "JGRISSOM169382@ECOMMUNITYDIRECT.COM",
            "affiliation": "N",
            "address_1": "6950 Hillsdale Ct",
            "city": "Indianapolis",
            "state": "IN",
            "country_code": "US",
            "postal_code": "462502040",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Brandon Austin Grindle, FNP
• Christopher Eric Grindle, MD
• Griot Drum
• John Thomas Gripe, M.D.
• Ethel Gripo, PT
• Katic Peters Grissom, OTR
• Morgan A Griswold, CRNA
• Anna Grobengieser
• Bria Grobey
• Lacey N Groce, MSN, FNP-C, CPN

• Clinical Social Worker in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Clinical Social Worker in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2020; 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.