Provider Demographics
NPI:1285987099
Name:GRANT, INGRID T (MA,MA)
Entity type:Individual
Prefix:
First Name:INGRID
Middle Name:T
Last Name:GRANT
Suffix:
Gender:F
Credentials:MA,MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3326 E BADGER RD
Mailing Address - Street 2:
Mailing Address - City:EVERSON
Mailing Address - State:WA
Mailing Address - Zip Code:98247-9232
Mailing Address - Country:US
Mailing Address - Phone:360-988-2641
Mailing Address - Fax:360-988-8983
Practice Address - Street 1:3326 E BADGER RD
Practice Address - Street 2:
Practice Address - City:EVERSON
Practice Address - State:WA
Practice Address - Zip Code:98247-9232
Practice Address - Country:US
Practice Address - Phone:360-988-2641
Practice Address - Fax:360-988-8983
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor