MEDICARE: MARIA JEAN BISHOP MS, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	4320-125	WI

General Provider Information

NPI Number	:	1700116555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA JEAN BISHOP MS, LPC

Provider Business Mailing Address
First Line	:	5621 W ANDOVER RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53219-2264
Country	:	US
Telephone Number	:	414-841-1388
Fax Number	:

Provider Business Practice Location Address
First Line	:	234 W FLORIDA ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-1659
Country	:	US
Telephone Number	:	414-841-1388
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2009
Last Update Date	:	12/29/2009

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