Provider Demographics
NPI:1073740445
Name:BISHOP, SIMONE (SLP-A)
Entity Type:Individual
Prefix:
First Name:SIMONE
Middle Name:
Last Name:BISHOP
Suffix:
Gender:F
Credentials:SLP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WEST 134TH STREET
Mailing Address - Street 2:
Mailing Address - City:GALLIANO
Mailing Address - State:LA
Mailing Address - Zip Code:70354
Mailing Address - Country:US
Mailing Address - Phone:985-632-7919
Mailing Address - Fax:985-632-7919
Practice Address - Street 1:200 WEST 134TH STREET
Practice Address - Street 2:
Practice Address - City:GALLIANO
Practice Address - State:LA
Practice Address - Zip Code:70354
Practice Address - Country:US
Practice Address - Phone:985-632-7919
Practice Address - Fax:985-632-7919
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA52422355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant