Provider Demographics
NPI:1285369116
Name:ROQUEBERT, KEEGAN VICTORIA (MS)
Entity type:Individual
Prefix:
First Name:KEEGAN
Middle Name:VICTORIA
Last Name:ROQUEBERT
Suffix:
Gender:
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6512 DESEO APT 126
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-3032
Mailing Address - Country:US
Mailing Address - Phone:972-816-9764
Mailing Address - Fax:
Practice Address - Street 1:400A HIGH SCHOOL DR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3635
Practice Address - Country:US
Practice Address - Phone:469-713-5203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-25
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HISPP-4235Z00000X
TX122582235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist