Provider Demographics
NPI:1215039201
Name:BISHOP, DANIEL WAYNE (PSYD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:WAYNE
Last Name:BISHOP
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 W SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-2417
Mailing Address - Country:US
Mailing Address - Phone:262-374-3445
Mailing Address - Fax:
Practice Address - Street 1:312 S 7TH ST STOP 2
Practice Address - Street 2:
Practice Address - City:DELAVAN
Practice Address - State:WI
Practice Address - Zip Code:53115-1964
Practice Address - Country:US
Practice Address - Phone:262-374-4444
Practice Address - Fax:844-247-2735
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15360-135101YM0800X
WI15348-132101YA0400X
WI4047-125101YP2500X
IL14303101YA0400X
103T00000X
IL180004694103TB0200X
WI320657103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral