Individual
KAITLIN SISSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CMT, NMT
Contact information
Practice address
7765 HEALDSBURG AVE STE 13C, SEBASTOPOL, CA 95472-3355
(707) 206-8569
Mailing address
714 WARREN LN, SANTA ROSA, CA 95401-5413
(707) 206-8569
Taxonomy
Speciality
Code
Description
License number
State
2083P0901X
Public Health & General Preventive Medicine Physician
Primary
90196
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
90196
CAMTC CERTIFICATION
CA
Enumeration date
11/08/2022
Last updated
11/08/2022
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