Provider Demographics
NPI:1497307946
Name:BISHOP, KENNETH CHARLES (CDCA,PEER SUPPOT)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:CHARLES
Last Name:BISHOP
Suffix:
Gender:M
Credentials:CDCA,PEER SUPPOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5257 ASHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-1037
Mailing Address - Country:US
Mailing Address - Phone:216-870-9796
Mailing Address - Fax:
Practice Address - Street 1:5257 ASHWOOD DR
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-1037
Practice Address - Country:US
Practice Address - Phone:216-870-9796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist