Provider Demographics
NPI:1891293155
Name:BARAK, JESSIE GINSBURG (SLP)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:GINSBURG
Last Name:BARAK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:JESSIE
Other - Middle Name:
Other - Last Name:GINSBURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:5910 NW 60TH AVE
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4406
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8645 N MILITARY TRL
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-6294
Practice Address - Country:US
Practice Address - Phone:561-619-9520
Practice Address - Fax:561-510-7152
Is Sole Proprietor?:No
Enumeration Date:2018-01-31
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ8455235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist