Healthcare Provider Details

I. General information

NPI: 1073459665
Provider Name (Legal Business Name): MINDY JOANNA BISHOP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36736 CANAL DR
TRAVER CA
93673-7118
US

IV. Provider business mailing address

941 11TH AVE
KINGSBURG CA
93631-2435
US

V. Phone/Fax

Practice location:
  • Phone: 559-897-2755
  • Fax:
Mailing address:
  • Phone: 559-730-2910
  • Fax: 559-733-6610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number13085
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: