Provider Demographics
NPI:1386654382
Name:STEIDL BISHOP, CYNTHIA L (LISW)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:L
Last Name:STEIDL BISHOP
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:L
Other - Last Name:STEIDL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:945 19TH STREET
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-1117
Mailing Address - Country:US
Mailing Address - Phone:515-241-0982
Mailing Address - Fax:515-241-0993
Practice Address - Street 1:1301 CENTER ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1004
Practice Address - Country:US
Practice Address - Phone:515-243-5181
Practice Address - Fax:515-243-2760
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA010071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0074583Medicaid
IA0074583Medicaid