Provider Demographics
NPI:1053514489
Name:GRIMM, BILL H (PHD)
Entity type:Individual
Prefix:DR
First Name:BILL
Middle Name:H
Last Name:GRIMM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13114 SHREFFLER DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-7867
Mailing Address - Country:US
Mailing Address - Phone:815-254-0634
Mailing Address - Fax:815-254-0635
Practice Address - Street 1:6912 MAIN ST
Practice Address - Street 2:SUITE 29
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-3447
Practice Address - Country:US
Practice Address - Phone:630-963-9381
Practice Address - Fax:815-254-0635
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL281045OtherVALUEOPTIONS PROVIDER NO.
IL022-73039OtherBCBSIL PROVIDER NUMBER