Lisa H Bernholz-Balsam, MS, CCC-SLP/A

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

41YS00359300 Issued in NJ

Practice address

214 Engle St
Suite 12
Englewood, NJ 07631-2443

Phone

(201) 871-5900

Fax

(201) 871-0059

NPI assigned

May 2, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1462147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462147200000",
    "number": "1083069645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "214 ENGLE ST",
            "address_2": "SUITE 12",
            "city": "ENGLEWOOD",
            "state": "NJ",
            "postal_code": "076312443",
            "telephone_number": "201-871-5900",
            "fax_number": "201-871-0059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "214 ENGLE ST",
            "address_2": "SUITE 12",
            "city": "ENGLEWOOD",
            "state": "NJ",
            "postal_code": "076312443",
            "telephone_number": "201-871-5900",
            "fax_number": "201-871-0059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERNHOLZ-BALSAM",
        "first_name": "LISA",
        "middle_name": "H",
        "credential": "MS, CCC-SLP/A",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-05-02",
        "last_updated": "2016-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "NJ",
            "license": "41YS00081400",
            "primary": false
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "NY",
            "license": "000968-1",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NJ",
            "license": "41YS00359300",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "4535",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Englewood, NJ
• Providers in Englewood, NJ by specialty
• Speech-Language Pathologist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.