Provider Demographics
NPI:1215039201
Name:BISHOP, DANIEL WAYNE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:WAYNE
Last Name:BISHOP
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 BROAD ST STE 2
Mailing Address - Street 2:
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-1800
Mailing Address - Country:US
Mailing Address - Phone:262-374-3444
Mailing Address - Fax:844-247-2735
Practice Address - Street 1:415 BROAD ST STE 2
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-1800
Practice Address - Country:US
Practice Address - Phone:262-374-3444
Practice Address - Fax:844-247-2735
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15348-132101YA0400X
IL14303101YA0400X
WI15360-135101YM0800X
WI4047-125101YP2500X
IL180004694103TB0200X
WI320657103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral