Cissom, Angela Marie

Cissom, Angela Marie is an individual health care provider with primary practice located at 4646 Poplar Ave Suite 100, Memphis TN 38117-4426. She recently has only one registered license in Speech, Language and Hearing Service Providers / Audiologist, which is considered as her primary health care specialty. Cissom, Angela Marie can be contacted via phone (901) 762-0125.

Contact Information

Primary practice address
4646 Poplar Ave Suite 100 Memphis TN 38117-4426
Phone: (901) 762-0125
Fax: (901) 818-3001
Website:
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Health care specialties

SpecialtyCodeLicense #State
Speech, Language and Hearing Service Providers / Audiologist 231H00000X 01274 Maryland

Profile Details

NPI number 1891045282
LBN Legal business name Cissom, Angela Marie
Credentials AUD
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 13th, 2012
Last updated Nov 8th, 2016 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1891045282 NPPES
Tennessee Other 1726 STATE OF TENNESSEE DEPARTMENT OF HEALTH DIVISION OF HEALTH RELATED BOARDS

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