Provider Demographics
NPI:1184714958
Name:PLASENCIA, IVIS MARCIA (SLPA)
Entity type:Individual
Prefix:
First Name:IVIS
Middle Name:MARCIA
Last Name:PLASENCIA
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14754 SW 9TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33194-2912
Mailing Address - Country:US
Mailing Address - Phone:305-228-3643
Mailing Address - Fax:
Practice Address - Street 1:8600 SW 92ND ST
Practice Address - Street 2:SUITE 204
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7397
Practice Address - Country:US
Practice Address - Phone:305-279-2428
Practice Address - Fax:305-596-9996
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI 9092355S0801X
222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant