Active NPI
Jennifer M Lisberger, MACCC/SLP
- Speech-Language Pathologist
- Philadelphia, PA
National Provider Identifier
1750988754
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SL009455
- Practice address
- 130 N 2ND St Unit 2C
Philadelphia, PA 19106-4604 - Phone
- (610) 316-9641
- NPI assigned
- Oct 4, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SL009455 | PA | Primary |
Addresses
Primary practice location
130 N 2ND St Unit 2C
Philadelphia, PA 19106-4604
Mailing address
130 N 2ND St Unit 2C
Philadelphia, PA 19106-4604
Phone (610) 316-9641
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SL009455 | PA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1601769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1601769600000",
"number": "1750988754",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "130 N 2ND ST UNIT 2C",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191064604",
"telephone_number": "610-316-9641"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 N 2ND ST UNIT 2C",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191064604",
"telephone_number": "610-316-9641"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LISBERGER",
"first_name": "JENNIFER",
"middle_name": "M",
"credential": "MACCC/SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-10-04",
"last_updated": "2020-10-04",
"certification_date": "2020-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Speech-Language Pathologist",
"state": "PA",
"license": "SL009455",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 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.