Healthcare Provider Details

I. General information

NPI: 1356463103
Provider Name (Legal Business Name): JEFFREY TODD BISHOP LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 04/21/2023
Certification Date: 04/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1624 TIFFIN AVE STE A
FINDLAY OH
45840-6852
US

IV. Provider business mailing address

10100 ELIDA RD
DELPHOS OH
45833-9056
US

V. Phone/Fax

Practice location:
  • Phone: 419-427-3320
  • Fax: 419-427-1697
Mailing address:
  • Phone: 419-685-8010
  • Fax: 419-932-6232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS 0020397
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: