Provider Demographics
NPI:1093028367
Name:DELEGAS, EVELYN S (CCC-A)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:S
Last Name:DELEGAS
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 MALL RD
Mailing Address - Street 2:LAHEY CLINIC
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:978-538-4361
Mailing Address - Fax:978-538-4748
Practice Address - Street 1:1 ESSEX CENTER DR
Practice Address - Street 2:LAHEY NORTHSHORE
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2901
Practice Address - Country:US
Practice Address - Phone:978-538-4361
Practice Address - Fax:978-538-4748
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA452231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5103967Medicaid
MA029964Medicare PIN