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NPI Code Detail

MEDICARE: CHRISTA TOTTY SISSON MCD, CCC-SLP

MEDICARE: CHRISTA TOTTY SISSON MCD, CCC-SLP
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
1106S00000XBehavior Technician
2235Z00000XSpeech-Language Pathologist27812CA

General Provider Information

NPI Number : 1720518822
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTA TOTTY SISSON MCD, CCC-SLP
Provider Business Mailing Address
First Line : 7845 WESTSIDE DR APT 114
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-1249
Country : US
Telephone Number : 931-994-7714
Fax Number :
Provider Business Practice Location Address
First Line : 7090 MIRATECH DR
Second Line :
City : SAN DIEGO
State : CA
Zip : 92121-3109
Country : US
Telephone Number : 858-304-6440
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2017
Last Update Date : 01/17/2019

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Directions to “ CHRISTA TOTTY SISSON MCD, CCC-SLP” Practice Location

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