Healthcare Provider Details

I. General information

NPI: 1043781230
Provider Name (Legal Business Name): KARISA MARIE NAGRANT MA CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARISA MARIE WENDLAND M.A. CCC-SLP

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 08/23/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 W WEBSTER RD
ROYAL OAK MI
48073-3852
US

IV. Provider business mailing address

2711 BEMBRIDGE RD
ROYAL OAK MI
48073-2922
US

V. Phone/Fax

Practice location:
  • Phone: 248-288-3100
  • Fax:
Mailing address:
  • Phone: 248-288-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101005192
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: