Provider Demographics
NPI:1144375353
Name:CUISON, AGNES (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:AGNES
Middle Name:
Last Name:CUISON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8351 EASTLEIGH CT
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-4066
Mailing Address - Country:US
Mailing Address - Phone:916-320-7899
Mailing Address - Fax:
Practice Address - Street 1:8351 EASTLEIGH CT
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-4066
Practice Address - Country:US
Practice Address - Phone:916-320-7899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP12992235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist