Provider Demographics
NPI:1598396525
Name:ULITSKY, ADELA (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ADELA
Middle Name:
Last Name:ULITSKY
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 GYPSY LN UNIT 625
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-5446
Mailing Address - Country:US
Mailing Address - Phone:215-917-7204
Mailing Address - Fax:
Practice Address - Street 1:3411 SILVERSIDE RD STE 105
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4806
Practice Address - Country:US
Practice Address - Phone:302-478-5240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEO4-0000629235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist