Provider Demographics
NPI:1770454472
Name:MUNGIA, KEELEY MOORE
Entity type:Individual
Prefix:
First Name:KEELEY
Middle Name:MOORE
Last Name:MUNGIA
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 1:1755 SHEPPARD REES RD APT B
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-7444
Mailing Address - Country:US
Mailing Address - Phone:325-206-1214
Mailing Address - Fax:
Practice Address - Street 1:232 HIGH ST
Practice Address - Street 2:
Practice Address - City:COMFORT
Practice Address - State:TX
Practice Address - Zip Code:78013-2286
Practice Address - Country:US
Practice Address - Phone:830-995-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122629235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist