Provider Demographics
NPI:1487447314
Name:MEDINA RIVERA, KAYSSIE MARIE (SLP)
Entity type:Individual
Prefix:
First Name:KAYSSIE
Middle Name:MARIE
Last Name:MEDINA RIVERA
Suffix:
Gender:F
Credentials: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 673
Mailing Address - Street 2:
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719-0673
Mailing Address - Country:US
Mailing Address - Phone:787-909-4408
Mailing Address - Fax:
Practice Address - Street 1:CARR 164 KM 6.2 BO ACHIOTE SECTOR TANITA MORALES
Practice Address - Street 2:
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719
Practice Address - Country:US
Practice Address - Phone:787-909-4408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4644235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist