Healthcare Provider Details

I. General information

NPI: 1073466488
Provider Name (Legal Business Name): WHITNEY M GRANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WHITNEY M WATSON GRANT

II. Dates (important events)

Enumeration Date: 02/16/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5910 GALLEY RD
COLORADO SPRINGS CO
80915-3736
US

IV. Provider business mailing address

4914 WAGON MASTER DR
COLORADO SPRINGS CO
80917-2221
US

V. Phone/Fax

Practice location:
  • Phone: 719-491-5687
  • Fax:
Mailing address:
  • Phone: 719-491-5687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: