Individual provider Active NPI

Heidi Ann Underwood, MS, CCC-SLP

  • Speech-Language Pathologist
  • Glens Falls, NY
National Provider Identifier
1174787030
Registry record updated Feb 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
0114202 Issued in NY
Practice address
13 Locust Street
Glens Falls, NY 12801
Phone
(518) 761-2025
Fax
(518) 761-2035
NPI assigned
Jul 10, 2008
Last updated
Feb 24, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2015

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 0114202 NY Primary

Addresses

Primary practice location

13 Locust Street
Glens Falls, NY 12801

Mailing address

13 Locust Street
Glens Falls, NY 12801
Phone (518) 761-2025

Other identifiers 1

IdentifierTypeStateIssuer
11580239OtherNYCAQH

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
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
0114202NYMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Adirondack Enrichment, a Speech Pathology Occupational Therapy and Phy Speech-Language Pathologist Past Accepting new patients

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1215648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424736000000",
    "number": "1174787030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13 LOCUST STREET",
            "city": "GLENS FALLS",
            "state": "NY",
            "postal_code": "12801",
            "telephone_number": "518-761-2025",
            "fax_number": "518-761-2035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13 LOCUST STREET",
            "city": "GLENS FALLS",
            "state": "NY",
            "postal_code": "12801",
            "telephone_number": "518-761-2025",
            "fax_number": "518-761-2035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UNDERWOOD",
        "first_name": "HEIDI",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "MS, CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-10",
        "last_updated": "2015-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "0114202",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11580239",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glens Falls, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2015; 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.