Healthcare Provider Details

I. General information

NPI: 1255914933
Provider Name (Legal Business Name): TIDESPEAK LANGUAGE & SPEECH THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2021
Last Update Date: 04/30/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2808 VILLAS WAY
SAN DIEGO CA
92108-6732
US

IV. Provider business mailing address

2808 VILLAS WAY
SAN DIEGO CA
92108-6732
US

V. Phone/Fax

Practice location:
  • Phone: 619-289-7782
  • Fax:
Mailing address:
  • Phone: 619-289-7782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTA TOTTY SISSON
Title or Position: SPEECH-LANGUAGE PATHOLOGIST/OWNER
Credential: MCD, CCC-SLP
Phone: 619-289-7782