MEDICARE: WHITNEY M WATSON GRANT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker		CO

General Provider Information

NPI Number	:	1073466488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WHITNEY M WATSON GRANT

Provider Business Mailing Address
First Line	:	4914 WAGON MASTER DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-2221
Country	:	US
Telephone Number	:	719-491-5687
Fax Number	:

Provider Business Practice Location Address
First Line	:	4914 WAGON MASTER DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-2221
Country	:	US
Telephone Number	:	719-491-5687
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2026
Last Update Date	:	02/16/2026

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