Provider Demographics
NPI:1568212819
Name:KSANZNAK, CHELSEA ROSE (MSW, LSW, MS,CCC-SLP)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:ROSE
Last Name:KSANZNAK
Suffix:
Gender:F
Credentials:MSW, LSW, MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2926 VILLAGE SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17315-4578
Mailing Address - Country:US
Mailing Address - Phone:570-582-8063
Mailing Address - Fax:
Practice Address - Street 1:8504 MAPLEVILLE RD
Practice Address - Street 2:
Practice Address - City:BOONSBORO
Practice Address - State:MD
Practice Address - Zip Code:21713-1817
Practice Address - Country:US
Practice Address - Phone:301-733-9067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-26
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL017578235Z00000X
MD33459104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist