Healthcare Provider Details

I. General information

NPI: 1740733641
Provider Name (Legal Business Name): GRETCHEN BISHOP MSW, LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2016
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 161
LAGRANGE OH
44050-0161
US

IV. Provider business mailing address

PO BOX 161
LAGRANGE OH
44050-0161
US

V. Phone/Fax

Practice location:
  • Phone: 216-438-0857
  • Fax:
Mailing address:
  • Phone: 216-438-0857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1901681
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1600483
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: