Individual provider Active NPI

Maryellen Udovich, SLP

  • Speech-Language Pathologist
  • New Castle, DE
National Provider Identifier
1508997545
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Practice address
318 E Basin Rd
New Castle, DE 19720-4214
Phone
(302) 323-2700
NPI assigned
Mar 9, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X DE Primary

Addresses

Primary practice location

318 E Basin Rd
New Castle, DE 19720-4214

Mailing address

318 E Basin Rd
New Castle, DE 19720-4214

Other identifiers 1

IdentifierTypeStateIssuer
0000367767MedicaidDE

Other names 1

  • Mary Ford Udovich Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
010000229DEMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
State of Delaware Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1508997545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "318 E BASIN RD",
            "city": "NEW CASTLE",
            "state": "DE",
            "postal_code": "197204214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "318 E BASIN RD",
            "city": "NEW CASTLE",
            "state": "DE",
            "postal_code": "197204214",
            "telephone_number": "302-323-2700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UDOVICH",
        "first_name": "MARYELLEN",
        "credential": "SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "DE",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0000367767",
            "state": "DE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "UDOVICH",
            "middle_name": "FORD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in New Castle, DE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.