Provider Demographics
NPI:1447706338
Name:UNDERWOOD, LAUREN (BA-SLPA)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:UNDERWOOD
Suffix:
Gender:
Credentials:BA-SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 W ROVEEN AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-1409
Mailing Address - Country:US
Mailing Address - Phone:908-675-2799
Mailing Address - Fax:
Practice Address - Street 1:6815 W CACTUS RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-5313
Practice Address - Country:US
Practice Address - Phone:623-937-5090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP15593235Z00000X
AZSLPA101352355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant