MEDICARE: AMY N SISSON MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	C0700266	OH

General Provider Information

NPI Number	:	1508194259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY N SISSON MA

Provider Business Mailing Address
First Line	:	POB 171
Second Line	:
City	:	VINTON
State	:	OH
Zip	:	45686
Country	:	US
Telephone Number	:	740-388-8567
Fax Number	:	740-388-8567

Provider Business Practice Location Address
First Line	:	53 MAIN STREET
Second Line	:
City	:	VINTON
State	:	OH
Zip	:	45686
Country	:	US
Telephone Number	:	740-388-8567
Fax Number	:	740-388-8567

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2009
Last Update Date	:	11/18/2009

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