Provider Demographics
NPI:1790469138
Name:GRANT, WINTER ALIAH (MA)
Entity Type:Individual
Prefix:
First Name:WINTER
Middle Name:ALIAH
Last Name:GRANT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 BACKWOODS RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29080-8636
Mailing Address - Country:US
Mailing Address - Phone:843-598-5760
Mailing Address - Fax:
Practice Address - Street 1:1119 PICK POCKET PLANTATION DR
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-3771
Practice Address - Country:US
Practice Address - Phone:877-367-9772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8006235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist