Sally Bardin, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

3762-125 Issued in WI

Practice address

101 Broad St Ste 201
Lake Geneva, WI 53147-2061

Phone

(262) 248-7942

Fax

(262) 248-1202

NPI assigned

Mar 13, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lake Geneva Wellness Clinic LLC

  • Clinical Psychologist
  • Lake Geneva, WI
  • NPI 1003845181
  NPD (past)

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1679606529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1116 ROYAL BIRKDALE CT",
            "city": "LAKE GENEVA",
            "state": "WI",
            "postal_code": "531475013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 BROAD ST STE 201",
            "city": "LAKE GENEVA",
            "state": "WI",
            "postal_code": "531472061",
            "telephone_number": "262-248-7942",
            "fax_number": "262-248-1202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BARDIN",
        "first_name": "SALLY",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "3762-125",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43715500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Balistreri & Associates Physical Therapy
• Suzanne Balistreri-Roden, P.T.
• Anshul B. Bamrolia, MD
• Matthew Banas
• Melisa Barber
• Ellen Grace Barnstable, MD
• Megan Batz
• Erin Bauman, NURSE PRACTITIONER
• Bee Happy Therapy, LLC
• Vanessa Bellei, PHARMD

• Professional Counselor in Lake Geneva, WI
• Providers in Lake Geneva, WI by specialty
• Professional Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.