Provider Demographics
NPI:1285879239
Name:UNDERWOOD, JESSICA LEANNE (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LEANNE
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:LEANNE
Other - Last Name:KISHPAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:33-57 HARRISON ST
Mailing Address - Street 2:UNITED HEALTH SERVICES
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2107
Mailing Address - Country:US
Mailing Address - Phone:607-763-6033
Mailing Address - Fax:607-763-6853
Practice Address - Street 1:33-57 HARRISON ST
Practice Address - Street 2:UNITED HEALTH SERVICES
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-2107
Practice Address - Country:US
Practice Address - Phone:607-763-6033
Practice Address - Fax:607-763-6853
Is Sole Proprietor?:No
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013917-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist