NPIMap

Organization Active NPI

Jennifer Bergman Ms CCC LLC

  • Speech-Language Pathologist
  • Marlton, NJ
National Provider Identifier
1558562199
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
41YS00090300 Issued in NJ
Legal business name
JENNIFER BERGMAN MS CCC LLC
Practice address
475 Old Marlton Pike W
Suite 1
Marlton, NJ 08053-2098
Phone
(856) 983-6160
NPI assigned
May 30, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ms. Jennifer Bergman, MS
Title
President
Phone
(856) 983-6160

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 41YS00090300 NJ Primary

Addresses

Primary practice location

475 Old Marlton Pike W
Suite 1
Marlton, NJ 08053-2098

Mailing address

475 Old Marlton Pike W
Suite 1
Marlton, NJ 08053-2098
Phone (856) 983-6160

Other identifiers 1

IdentifierTypeStateIssuer
41YS00090300OtherNJLICENSE

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1558562199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "475 OLD MARLTON PIKE W",
            "address_2": "SUITE 1",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080532098",
            "telephone_number": "856-983-6160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 OLD MARLTON PIKE W",
            "address_2": "SUITE 1",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080532098",
            "telephone_number": "856-983-6160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JENNIFER BERGMAN MS CCC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BERGMAN",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "856-983-6160",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MS"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NJ",
            "license": "41YS00090300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "41YS00090300",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marlton, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.