Provider Demographics
NPI:1750530093
Name:TISSOT, ABBIGAIL MAY (PHD)
Entity type:Individual
Prefix:
First Name:ABBIGAIL
Middle Name:MAY
Last Name:TISSOT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ABBIGAIL
Other - Middle Name:MAY
Other - Last Name:WANCHICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:3333 BURNET AVE
Mailing Address - Street 2:MLC 4000
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-803-2911
Mailing Address - Fax:513-636-8844
Practice Address - Street 1:3333 BURNET AVE
Practice Address - Street 2:MLC 4000
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-803-2911
Practice Address - Fax:513-636-8844
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6822103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist