Provider Demographics
NPI:1316138555
Name:BERCH, LISA MARIE (MA, CCC-A)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:BERCH
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:LYONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-A
Mailing Address - Street 1:23895 NOVI ROAD
Mailing Address - Street 2:SUITE #100
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375
Mailing Address - Country:US
Mailing Address - Phone:248-348-4327
Mailing Address - Fax:248-348-6464
Practice Address - Street 1:23895 NOVI ROAD
Practice Address - Street 2:SUITE #100
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375
Practice Address - Country:US
Practice Address - Phone:248-348-4327
Practice Address - Fax:248-348-4327
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000085231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1316138555Medicaid
MIN71920012Medicare PIN