Provider Demographics
NPI:1649812280
Name:BISHOP, JOCELYN MIGUEL (SLP)
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:MIGUEL
Last Name:BISHOP
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1383 REBECCA WAY
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-2965
Mailing Address - Country:US
Mailing Address - Phone:707-540-5351
Mailing Address - Fax:
Practice Address - Street 1:1383 REBECCA WAY
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-2965
Practice Address - Country:US
Practice Address - Phone:707-540-5351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist