Provider Demographics
NPI:1821660226
Name:BISHOP, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BISHOP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7579 WISTERIA DR
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-6982
Mailing Address - Country:US
Mailing Address - Phone:626-874-6729
Mailing Address - Fax:662-874-6727
Practice Address - Street 1:7579 WISTERIA DR
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-6982
Practice Address - Country:US
Practice Address - Phone:626-874-6729
Practice Address - Fax:662-874-6727
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist