Marissa Lauren Bergsma, M.S. CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

7101004623 Issued in MI

Practice address

2786 56TH St SW
Wyoming, MI 49418-8708

Phone

(616) 261-3960

NPI assigned

Oct 29, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Miss Marissa Lauren Orr Former name

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": "1509235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1509235200000",
    "number": "1891207080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2915 EARLE AVE SW",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "494181467",
            "telephone_number": "616-260-3174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2786 56TH ST SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "494188708",
            "telephone_number": "616-261-3960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGSMA",
        "first_name": "MARISSA",
        "middle_name": "LAUREN",
        "name_prefix": "Mrs.",
        "credential": "M.S. CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-10-29",
        "last_updated": "2017-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MI",
            "license": "7101004623",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARISSA",
            "last_name": "ORR",
            "middle_name": "LAUREN",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• David Douglas Berg, D.O.
• Jessica Bergers, RD, CDE
• David Jon Berghuis, M.A., L.L.P.
• Robert Bergman, LLMSW
• Derek Paul Bergsma, M.D.
• Abigail Berkey
• Jillian Berzley
• Best Practices Inpatient Care,LTD
• Daniel Claude Bethel, LMSW
• Lee Ann Betts

• Speech-Language Pathologist in Wyoming, MI
• Providers in Wyoming, MI by specialty
• Speech-Language Pathologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2017; 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.