Healthcare Provider Details

I. General information

NPI: 1891637799
Provider Name (Legal Business Name): MARCUS PLASCENCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 S LAWE ST
APPLETON WI
54915-2473
US

IV. Provider business mailing address

1212 AUGUSTA WEST PKWY STE 1B
AUGUSTA GA
30909-1808
US

V. Phone/Fax

Practice location:
  • Phone: 920-268-1998
  • Fax:
Mailing address:
  • Phone: 706-826-2770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: