Provider Demographics
NPI:1154540177
Name:BISHOP, LISA DIANE
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:DIANE
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 1:4807 WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-8939
Mailing Address - Country:US
Mailing Address - Phone:573-727-9166
Mailing Address - Fax:573-727-9726
Practice Address - Street 1:4807 WEST BLVD
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-8939
Practice Address - Country:US
Practice Address - Phone:573-727-9166
Practice Address - Fax:573-727-9726
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001292237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist