Provider Demographics
NPI:1144775933
Name:SISSONS, KRISTINE IGNACIO CARAIG
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:IGNACIO CARAIG
Last Name:SISSONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18520 NE 109TH AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-9462
Mailing Address - Country:US
Mailing Address - Phone:909-557-3782
Mailing Address - Fax:
Practice Address - Street 1:18520 NE 109TH AVE
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-9462
Practice Address - Country:US
Practice Address - Phone:909-557-3782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-22
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist