Provider Demographics
NPI:1316116973
Name:BISHOP, LILLIAN RONDA (MED)
Entity type:Individual
Prefix:MRS
First Name:LILLIAN
Middle Name:RONDA
Last Name:BISHOP
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:LILLIAN
Other - Middle Name:
Other - Last Name:PROCTOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4615 154TH AVE CT E
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-2819
Mailing Address - Country:US
Mailing Address - Phone:253-826-4352
Mailing Address - Fax:
Practice Address - Street 1:1818 MAIN STREET
Practice Address - Street 2:SUITE C
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390-2819
Practice Address - Country:US
Practice Address - Phone:253-863-1997
Practice Address - Fax:253-863-1997
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00010219101Y00000X
OK1995101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor