Provider Demographics
NPI:1811200298
Name:BISHOP, THOMAS (MS)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:BISHOP
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 LARKFIELD CTR # 310
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-1408
Mailing Address - Country:US
Mailing Address - Phone:775-354-9706
Mailing Address - Fax:
Practice Address - Street 1:5460 SKYLANE BLVD STE C
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1793
Practice Address - Country:US
Practice Address - Phone:775-354-9706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1122235Z00000X
CA31750235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1122OtherSPEECH PATHOLOGY