Provider Demographics
NPI:1124163027
Name:BISHOP, MICHELLE L (AUD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:BISHOP
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 E SUNSET RD
Mailing Address - Street 2:UNIT 5-260
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-3511
Mailing Address - Country:US
Mailing Address - Phone:702-798-0113
Mailing Address - Fax:866-291-5242
Practice Address - Street 1:638 RAILROAD ST
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-9256
Practice Address - Country:US
Practice Address - Phone:541-469-3511
Practice Address - Fax:541-469-5977
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23064237600000X
CAAU2827231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist