Individual
MICHELLE A GRIMM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED
Contact information
Practice address
504 LAKELAND RD, SHAWANO, WI 54166-3836
(715) 526-5547
(715) 526-5542
Mailing address
504 LAKELAND RD, SHAWANO, WI 54166-3836
(715) 526-5547
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
14267
WI
101YP2500X
Professional Counselor
Primary
3370125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40968400
—
WI
Enumeration date
09/06/2007
Last updated
09/06/2007
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