Provider Demographics
NPI:1417926320
Name:BISHOP, MARY ELIZABETH (MED, CCC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELIZABETH
Last Name:BISHOP
Suffix:
Gender:F
Credentials:MED, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1467 VACATION WAY
Mailing Address - Street 2:
Mailing Address - City:MILLERS CREEK
Mailing Address - State:NC
Mailing Address - Zip Code:28651-8188
Mailing Address - Country:US
Mailing Address - Phone:919-920-9884
Mailing Address - Fax:855-854-4447
Practice Address - Street 1:1467 VACATION WAY
Practice Address - Street 2:
Practice Address - City:MILLERS CREEK
Practice Address - State:NC
Practice Address - Zip Code:28651-8188
Practice Address - Country:US
Practice Address - Phone:919-920-9884
Practice Address - Fax:855-854-4447
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO01070846231H00000X
COSLP.0001417235Z00000X
NC10766235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO38478331Medicaid