Healthcare Provider Details

I. General information

NPI: 1285369116
Provider Name (Legal Business Name): KEEGAN VICTORIA ROQUEBERT M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2022
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400A HIGH SCHOOL DR
LEWISVILLE TX
75057-3635
US

IV. Provider business mailing address

6512 DESEO APT 126
IRVING TX
75039-3032
US

V. Phone/Fax

Practice location:
  • Phone: 469-713-5203
  • Fax:
Mailing address:
  • Phone: 972-816-9764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSPP-4
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number122582
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: