Provider Demographics
NPI:1790196277
Name:SISSON, REBECCA (LGC)
Entity Type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:
Last Name:SISSON
Suffix:
Gender:F
Credentials:LGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 BURNET AVE # MLC4006
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-9626
Mailing Address - Fax:513-636-7297
Practice Address - Street 1:3333 BURNET AVE # MLC4006
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-636-9626
Practice Address - Fax:513-636-7297
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS