Provider Demographics
NPI:1366717795
Name:BANCAYAN, JACQUELINE CRISTY (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:CRISTY
Last Name:BANCAYAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 432
Mailing Address - Street 2:
Mailing Address - City:SPICEWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:78669-0432
Mailing Address - Country:US
Mailing Address - Phone:512-644-0736
Mailing Address - Fax:
Practice Address - Street 1:22813 STATE HIGHWAY 71 W
Practice Address - Street 2:
Practice Address - City:SPICEWOOD
Practice Address - State:TX
Practice Address - Zip Code:78669-6465
Practice Address - Country:US
Practice Address - Phone:512-644-0736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-19
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105473235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist