Provider Demographics
NPI:1316035504
Name:BISHOP, LISA C (MCD,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:C
Last Name:BISHOP
Suffix:
Gender:F
Credentials:MCD,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1077 CORIE CREST DRIVE
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29316
Mailing Address - Country:US
Mailing Address - Phone:864-838-0768
Mailing Address - Fax:864-752-1072
Practice Address - Street 1:108 WILLIS PLAZA
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29341
Practice Address - Country:US
Practice Address - Phone:864-902-8512
Practice Address - Fax:864-752-1072
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3919235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist