MEDICARE: CAROLYN COURTMAN-GRANADOS

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	235Z00000X	Speech-Language Pathologist	SP-4215	NV

General Provider Information

NPI Number	:	1679436422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN COURTMAN-GRANADOS

Provider Business Mailing Address
First Line	:	7469 W LAKE MEAD BLVD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-1030
Country	:	US
Telephone Number	:	702-337-2938
Fax Number	:	702-442-0956

Provider Business Practice Location Address
First Line	:	7469 W LAKE MEAD BLVD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-1030
Country	:	US
Telephone Number	:	702-337-2938
Fax Number	:	702-442-0956

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

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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Directions to “ CAROLYN COURTMAN-GRANADOS ” Practice Location

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