Provider Demographics
NPI:1861218661
Name:STEPHENSON, SISKO CHRISTINE
Entity type:Individual
Prefix:
First Name:SISKO
Middle Name:CHRISTINE
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SISKO
Other - Middle Name:CHRISTINE
Other - Last Name:GRACEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1001 FOLSOM ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-4016
Mailing Address - Country:US
Mailing Address - Phone:510-239-9178
Mailing Address - Fax:
Practice Address - Street 1:1001 FOLSOM ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-4016
Practice Address - Country:US
Practice Address - Phone:510-239-9178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator