Provider Demographics
NPI:1144558677
Name:UNDERWOOD, TERA LEANN (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:TERA
Middle Name:LEANN
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 SW 129TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-6991
Mailing Address - Country:US
Mailing Address - Phone:405-691-6074
Mailing Address - Fax:
Practice Address - Street 1:604 S CLASSEN AVE
Practice Address - Street 2:#A
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-5401
Practice Address - Country:US
Practice Address - Phone:405-735-6333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-20
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2431235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist