Individual
ETHEL UNDERWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
100 MUSTANG DR, ANDERSON, MO 64831-7305
(417) 845-3409
(417) 845-7053
Mailing address
100 MUSTANG DR, ANDERSON, MO 64831-7305
(417) 845-3409
(417) 845-7053
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
0350162
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
506163104
—
MO
Enumeration date
07/15/2008
Last updated
07/15/2008
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