Provider Demographics
NPI:1902924186
Name:DELBARCO UNGAR, KERRI ALICIA (MS CCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:KERRI
Middle Name:ALICIA
Last Name:DELBARCO UNGAR
Suffix:
Gender:F
Credentials:MS CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 SW 30TH ST STE E
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-2985
Mailing Address - Country:US
Mailing Address - Phone:727-291-2179
Mailing Address - Fax:772-600-8274
Practice Address - Street 1:1151 SW 30TH ST STE E
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-2985
Practice Address - Country:US
Practice Address - Phone:727-291-2179
Practice Address - Fax:772-600-8274
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8128235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59184OtherBCBS
FL889970300Medicaid