Healthcare Provider Details

I. General information

NPI: 1376460972
Provider Name (Legal Business Name): TRISHA LYNN GRANT MSSW, APSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 S PARK ST
MADISON WI
53715-1507
US

IV. Provider business mailing address

265 KENSINGTON DR
MADISON WI
53704-5952
US

V. Phone/Fax

Practice location:
  • Phone: 608-417-5921
  • Fax: 608-417-6051
Mailing address:
  • Phone: 608-417-5921
  • Fax: 608-417-6051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: