Provider Demographics
NPI:1144918293
Name:BISHOP, MEGAN CATHLEEN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:CATHLEEN
Last Name:BISHOP
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23253 LYNNHURST ST
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042-5479
Mailing Address - Country:US
Mailing Address - Phone:810-869-8510
Mailing Address - Fax:
Practice Address - Street 1:51145 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NEW BALTIMORE
Practice Address - State:MI
Practice Address - Zip Code:48047-2100
Practice Address - Country:US
Practice Address - Phone:586-251-0840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101008032235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist