Provider Demographics
NPI:1669296810
Name:BISHOP, JENNIFER
Entity type:Individual
Prefix:
First Name:JENNIFER
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 1:108 HUNTS AVE
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND
Mailing Address - State:IA
Mailing Address - Zip Code:52749-9100
Mailing Address - Country:US
Mailing Address - Phone:563-343-7651
Mailing Address - Fax:
Practice Address - Street 1:319 E 2ND ST STE 204
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-4100
Practice Address - Country:US
Practice Address - Phone:563-343-7651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health