MEDICARE: MS. TERRY SUE UNDERWOOD M.A.ED.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YS0200X	School Counselor		AZ

General Provider Information

NPI Number	:	1831355577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TERRY SUE UNDERWOOD M.A.ED.

Provider Business Mailing Address
First Line	:	4311 E. LINDEN ST.
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-3240
Country	:	US
Telephone Number	:	520-232-8100
Fax Number	:

Provider Business Practice Location Address
First Line	:	4311 E LINDEN ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-3240
Country	:	US
Telephone Number	:	520-232-8100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2008
Last Update Date	:	08/01/2008

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