| Doctor Name: | MRS. JENNIFER JACKSON GRISMER |
| NPI Number: | 1316190986 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | L.C.S.W. |
| License Number: | 6801062059 |
| Business Practice Address: | 12 Berwick Ave Walden, NY - 125861646 |
| Business Phone Number: | 8457788502 |
| Business Fax Number: | |
| Mailing Address: | 12 Berwick Ave, WALDEN |
| State: | NY |
| Postal Code: | 125861646 |
| Phone Number: | 8457788502 |
| Fax Number: | |
| NPI Enumeration Date: | 10/28/2008 |
| NPI Last Update Date: | 10/28/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 6801062059 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |