Provider Demographics
NPI:1760376404
Name:EGIPCIACO, KEISHLA MARIE
Entity type:Individual
Prefix:MS
First Name:KEISHLA
Middle Name:MARIE
Last Name:EGIPCIACO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 4 BOX 14949
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-9677
Mailing Address - Country:US
Mailing Address - Phone:939-881-0873
Mailing Address - Fax:
Practice Address - Street 1:133 CALLE DR GONZALEZ
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-2633
Practice Address - Country:US
Practice Address - Phone:787-872-8365
Practice Address - Fax:787-872-4665
Is Sole Proprietor?:No
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR77992355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant