Provider Demographics
NPI:1255709747
Name:BISHOP-COOK, VIVIAN SWEETHEART
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:SWEETHEART
Last Name:BISHOP-COOK
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 1:625 KNOLL TER
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-3321
Mailing Address - Country:US
Mailing Address - Phone:920-713-4632
Mailing Address - Fax:
Practice Address - Street 1:2920 SOUTH WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301
Practice Address - Country:US
Practice Address - Phone:920-632-4471
Practice Address - Fax:920-632-4315
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health