Provider Demographics
NPI:1174787030
Name:UNDERWOOD, HEIDI ANN (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:ANN
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 LOCUST STREET
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801
Mailing Address - Country:US
Mailing Address - Phone:518-761-2025
Mailing Address - Fax:518-761-2035
Practice Address - Street 1:13 LOCUST STREET
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801
Practice Address - Country:US
Practice Address - Phone:518-761-2025
Practice Address - Fax:518-761-2035
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0114202235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11580239OtherCAQH