Provider Demographics
NPI:1104485697
Name:DELSACK, BARBARA S (MD, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:S
Last Name:DELSACK
Suffix:
Gender:F
Credentials:MD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 N MARKET ST APT 1
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-5237
Mailing Address - Country:US
Mailing Address - Phone:301-642-6984
Mailing Address - Fax:
Practice Address - Street 1:MONTGOMERY COUNTY PUBLIC SCHOOLS
Practice Address - Street 2:850 HUNGERFORD DRIVE
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850
Practice Address - Country:US
Practice Address - Phone:240-740-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08351235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist