Jacqueline Cristy Bancayan, M.S., CCC-SLP

Key facts

NPI

1366717795

Entity type

Individual (NPI type 1)

Primary specialty

Speech-Language Pathologist 235Z00000X

License

105473 (TX)

Practice address

22813 State Highway 71 W
Spicewood, TX 78669-6465

Phone

(512) 644-0736

NPI assigned

Mar 19, 2012

Sex

Female

Sole proprietor

Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sun Rises Speech & Language Services, PLLC Speech-Language Pathologist · Spicewood, TX · NPI 1447845078
  NPD SPEECH-LANGUAGE PATHOLOGIST

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Master of Science

State licenses

Practice roles

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 5, 2021.

{
    "created_epoch": "1332115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614902400000",
    "number": "1366717795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 432",
            "city": "SPICEWOOD",
            "state": "TX",
            "postal_code": "786690432",
            "telephone_number": "512-644-0736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22813 STATE HIGHWAY 71 W",
            "city": "SPICEWOOD",
            "state": "TX",
            "postal_code": "786696465",
            "telephone_number": "512-644-0736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANCAYAN",
        "first_name": "JACQUELINE",
        "middle_name": "CRISTY",
        "credential": "M.S., CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-03-19",
        "last_updated": "2021-03-05",
        "certification_date": "2021-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TX",
            "license": "105473",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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