Healthcare Provider Details

I. General information

NPI: 1598396525
Provider Name (Legal Business Name): ADELA ULITSKY M.A CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2020
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3411 SILVERSIDE RD STE 105
WILMINGTON DE
19810-4806
US

IV. Provider business mailing address

4000 GYPSY LN UNIT 625
PHILADELPHIA PA
19129-5446
US

V. Phone/Fax

Practice location:
  • Phone: 302-478-5240
  • Fax:
Mailing address:
  • Phone: 215-917-7204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberO4-0000629
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: