Adirondack Enrichment, a Speech Pathology Occupational Therapy and Phy

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

011402 Issued in NY

Legal business name

ADIRONDACK ENRICHMENT, A SPEECH PATHOLOGY OCCUPATIONAL THERAPY AND PHY

Practice address

413 Bay Rd
Queensbury, NY 12804-1408

Phone

(518) 761-2025

Fax

(518) 761-2035

NPI assigned

Jul 10, 2008

Organization subpart

No

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

Authorized official

Name

Heidi Underwood, MS,CCC-SLPNPI 1174787030

Title

Owner/Director

Phone

(518) 761-2025

Specialties & licenses 5

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kristin K Starling-Doty, DPT

  • Physical Therapist
  • Queensbury, NY
  • NPI 1295835585

  NY

  Medicare reassignment NPD
• Heidi Ann Underwood, MS, CCC-SLP

  • Speech-Language Pathologist
  • Glens Falls, NY
  • NPI 1174787030
  NPD (past) Authorized official
• Jean M McMahon

  • Occupational Therapist
  • Glens Falls, NY
  • NPI 1780848655
  NPD (past)
• Kristine Elisabeth Nailor

  • Speech-Language Pathologist
  • Glens Falls, NY
  • NPI 1972767853
  NPD (past)

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

{
    "created_epoch": "1215648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618790400000",
    "number": "1497919351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "413 BAY RD",
            "city": "QUEENSBURY",
            "state": "NY",
            "postal_code": "128041408",
            "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": "413 BAY RD",
            "city": "QUEENSBURY",
            "state": "NY",
            "postal_code": "128041408",
            "telephone_number": "518-761-2025",
            "fax_number": "518-761-2035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADIRONDACK ENRICHMENT, A SPEECH PATHOLOGY OCCUPATIONAL THERAPY AND PHY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-10",
        "last_updated": "2021-04-19",
        "certification_date": "2021-04-19",
        "status": "A",
        "authorized_official_last_name": "UNDERWOOD",
        "authorized_official_first_name": "HEIDI",
        "authorized_official_title_or_position": "OWNER/DIRECTOR",
        "authorized_official_telephone_number": "518-761-2025",
        "authorized_official_credential": "MS,CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "NY",
            "license": "0044171",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "011402",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "0163461",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "019159-1",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1174787030",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11580239",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11864562",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11864560",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1811127590",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1972767853",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1780848655",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Adirondack Counseling Traci Phillips LCSW PLLC
• Adirondack Cross Roads Psychology PLLC
• Adirondack Diagnostic Imaging of Queensbury
• Adirondack Enrichment
• Adirondack Enrichment
• Adirondack Health Institute
• Adirondack Manor Home for Adults
• Adirondack Manual Physical Therapy, PLLC
• Adirondack Radiology Associates, P.C.
• Adirondack Radiology Associates, PC

• All providers in Queensbury, NY
• Speech-Language Pathologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.