Active NPI
Justin Grimes, M.S, CFY-SLP
- Speech-Language Pathologist
- Crestview, FL
National Provider Identifier
1871930974
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SZ6217
- Practice address
- 4100 S Ferdon Blvd Ste A1
Crestview, FL 32536-5287 - Phone
- (850) 994-3456
- NPI assigned
- May 29, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SZ6217 | FL | Primary |
Addresses
Primary practice location
4100 S Ferdon Blvd Ste A1
Crestview, FL 32536-5287
Mailing address
4100 S Ferdon Blvd Ste A1
Crestview, FL 32536-5287
Phone (850) 994-3456
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SZ6217 | FL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1369785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1369785600000",
"number": "1871930974",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4100 S FERDON BLVD STE A1",
"city": "CRESTVIEW",
"state": "FL",
"postal_code": "325365287",
"telephone_number": "850-994-3456"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4100 S FERDON BLVD STE A1",
"city": "CRESTVIEW",
"state": "FL",
"postal_code": "325365287",
"telephone_number": "850-994-3456"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRIMES",
"first_name": "JUSTIN",
"credential": "M.S, CFY-SLP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-05-29",
"last_updated": "2013-05-29",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "FL",
"license": "SZ6217",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Crestview, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.