Provider Demographics
NPI:1972765212
Name:PLAISANCE, CYNTHIA (MACCC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:PLAISANCE
Suffix:
Gender:F
Credentials:MACCC
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:PLAISANCE
Other - Last Name:SHIVEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MACCC
Mailing Address - Street 1:11301 WILSHIRE BLVD
Mailing Address - Street 2:WLA VA MEDICAL CENTER AUDIOLOGY & SPEECH 126
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90073
Mailing Address - Country:US
Mailing Address - Phone:310-478-3711
Mailing Address - Fax:
Practice Address - Street 1:11301 WILSHIRE BLVD
Practice Address - Street 2:WLA VA MEDICAL CENTER AUDIOLOGY & SPEECH 126
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90073
Practice Address - Country:US
Practice Address - Phone:310-478-3711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP4320235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist