Provider Demographics
NPI:1881307742
Name:GRILLOS, BRYNNA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:BRYNNA
Middle Name:
Last Name:GRILLOS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:BRYNNA
Other - Middle Name:
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7960 RAFAEL RIVERA WAY UNIT 1336
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-5357
Mailing Address - Country:US
Mailing Address - Phone:409-853-2341
Mailing Address - Fax:
Practice Address - Street 1:7281 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1592
Practice Address - Country:US
Practice Address - Phone:702-870-7050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-05
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120535235Z00000X
NVSP-3973235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist