Provider Demographics
NPI:1316450513
Name:BISHOP, HEIDI SUE (LISW)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:SUE
Last Name:BISHOP
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1479 COLLINS AVE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-8808
Mailing Address - Country:US
Mailing Address - Phone:937-642-1065
Mailing Address - Fax:
Practice Address - Street 1:1479 COLLINS AVE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-8808
Practice Address - Country:US
Practice Address - Phone:937-642-1065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.16008951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical