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General NPI Number Information
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NPI Number | 1811307903
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Entity Type | Individual
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Provider Name | TRAVIS UNDERWOOD LISW
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Gender | Male
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Dates
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Enumeration Date | 04/29/2014
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Last Update Date | 10/07/2022
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Provider Practice Location Address
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Address Line | 226 WEST MAIN ST STE 201
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City | OTTUMWA
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State | IA
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Zip | 52501-2520
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Country | US
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Telephone | 641-682-4804
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Fax | 641-814-5684
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Provider Business Mailing Address
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Address Line | 301 BURLINGTON
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City | FAIRFIELD
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State | IA
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Zip | 52556-3242
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Country | US
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Telephone | 641-682-8772
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Fax | 641-682-1924
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 007987
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 007987
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License Number State | IA
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