Healthcare Provider Details

I. General information

NPI: 1679436422
Provider Name (Legal Business Name): CAROLYN COURTMAN-GRANADOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7469 W LAKE MEAD BLVD STE 100
LAS VEGAS NV
89128-1030
US

IV. Provider business mailing address

7469 W LAKE MEAD BLVD STE 100
LAS VEGAS NV
89128-1030
US

V. Phone/Fax

Practice location:
  • Phone: 702-337-2938
  • Fax: 702-442-0956
Mailing address:
  • Phone: 702-337-2938
  • Fax: 702-442-0956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP-4215
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: