Provider Demographics
NPI:1720518822
Name:SISSON, CHRISTA TOTTY (MCD, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:TOTTY
Last Name:SISSON
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:CHRISTA
Other - Middle Name:MARIE
Other - Last Name:TOTTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MCD, CF-SLP
Mailing Address - Street 1:7845 WESTSIDE DR APT 114
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1249
Mailing Address - Country:US
Mailing Address - Phone:931-994-7714
Mailing Address - Fax:
Practice Address - Street 1:7090 MIRATECH DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3109
Practice Address - Country:US
Practice Address - Phone:858-304-6440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
CA27812235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician