Provider Demographics
NPI:1568768364
Name:BISHOP, SUSAN DEBBIE (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:DEBBIE
Last Name:BISHOP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-0428
Mailing Address - Country:US
Mailing Address - Phone:503-359-1515
Mailing Address - Fax:503-359-1433
Practice Address - Street 1:2031 HAWTHORNE ST STE C
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-1700
Practice Address - Country:US
Practice Address - Phone:503-359-1515
Practice Address - Fax:503-359-1433
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-27
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372600000X
OR85231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No372600000XNursing Service Related ProvidersAdult Companion