Provider Demographics
NPI:1043781230
Name:NAGRANT, KARISA MARIE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KARISA
Middle Name:MARIE
Last Name:NAGRANT
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:KARISA
Other - Middle Name:MARIE
Other - Last Name:WENDLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:14153 RICK DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-2951
Mailing Address - Country:US
Mailing Address - Phone:586-566-0326
Mailing Address - Fax:
Practice Address - Street 1:14153 RICK DR
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-2951
Practice Address - Country:US
Practice Address - Phone:586-566-0326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101005192235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist