Healthcare Provider Details

I. General information

NPI: 1376400127
Provider Name (Legal Business Name): ALISON CHENOWETH
Entity Type: Individual
Gender:
Sole Proprietor: Y

Provider Other Name: ALISON UNDERWOOD

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SEA HAWK WAY
REDONDO BEACH CA
90277-2976
US

IV. Provider business mailing address

1 SEA HAWK WAY
REDONDO BEACH CA
90277-2976
US

V. Phone/Fax

Practice location:
  • Phone: 310-798-8665
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number230147772
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: