Organization
INNOVATIVE SUPPORT SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JODI BETH BISHOP (CEO)
(814) 631-9477
Entity
Organization
Contact information
Practice address
8344 WOODBURY PIKE UNIT 101, ROARING SPRING, PA 16673-8107
(814) 934-4351
(814) 201-2035
Mailing address
630 PLEASANT VALLEY BLVD STE C, ALTOONA, PA 16602-4871
(814) 631-9477
(814) 201-2035
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
07/07/2020
Last updated
07/07/2020
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