Provider Demographics
NPI:1043519077
Name:UNDERWOOD, SAMANTHA JOY (LMSW)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JOY
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12425 W 120TH ST
Mailing Address - Street 2:APT. 1022
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-4838
Mailing Address - Country:US
Mailing Address - Phone:913-702-4077
Mailing Address - Fax:913-894-0908
Practice Address - Street 1:12351 W 96TH TER
Practice Address - Street 2:SUITE 300
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-4409
Practice Address - Country:US
Practice Address - Phone:913-894-0900
Practice Address - Fax:913-894-8908
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7557104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS23-7368880Medicaid