Provider Demographics
NPI:1013660737
Name:SISSON, MAKENNA MARIE (MCD, CFY-SLP)
Entity Type:Individual
Prefix:
First Name:MAKENNA
Middle Name:MARIE
Last Name:SISSON
Suffix:
Gender:F
Credentials:MCD, CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6815 ISAACS ORCHARD RD STE D
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-6285
Mailing Address - Country:US
Mailing Address - Phone:479-856-6400
Mailing Address - Fax:
Practice Address - Street 1:6815 ISAACS ORCHARD RD STE D
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-6285
Practice Address - Country:US
Practice Address - Phone:479-856-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR201712235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty