MEDICARE: DANELL UNDERWOOD LSCSW

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	1041C0700X	Clinical Social Worker	2067	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	070682	OTHER	KS	BLUE CROSS BLUE SHIELD
2	8984	OTHER	KS	PREFERRED HEALTH SYSTEMS

General Provider Information

NPI Number	:	1023055670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANELL UNDERWOOD LSCSW

Provider Business Mailing Address
First Line	:	806 SW 12TH ST APT 15
Second Line	:
City	:	TOPEKA
State	:	KS
Zip	:	66612-1777
Country	:	US
Telephone Number	:	316-535-1143
Fax Number	:

Provider Business Practice Location Address
First Line	:	806 SW 12TH ST APT 15
Second Line	:
City	:	TOPEKA
State	:	KS
Zip	:	66612-1777
Country	:	US
Telephone Number	:	316-535-1143
Fax Number	:

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

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	06/29/2023

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Directions to “ DANELL UNDERWOOD LSCSW” Practice Location

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