Healthcare Provider Details

I. General information

NPI: 1184714958
Provider Name (Legal Business Name): IVIS MARCIA PLASENCIA SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 SW 92ND ST SUITE 204
MIAMI FL
33156-7397
US

IV. Provider business mailing address

14754 SW 9TH LN
MIAMI FL
33194-2912
US

V. Phone/Fax

Practice location:
  • Phone: 305-279-2428
  • Fax: 305-596-9996
Mailing address:
  • Phone: 305-228-3643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI 909
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: