MEDICARE: JENNIFER LEA PUTZ MSW, LMSW

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	104100000X	Social Worker	081441	IA

General Provider Information

NPI Number	:	1306352208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LEA PUTZ MSW, LMSW

Provider Business Mailing Address
First Line	:	800 W ASHLAND AVE
Second Line	:
City	:	INDIANOLA
State	:	IA
Zip	:	50125-2330
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 VALLEY WEST DR STE 306
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-1904
Country	:	US
Telephone Number	:	515-267-1340
Fax Number	:

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

Provider Enumeration Date	:	12/14/2017
Last Update Date	:	12/14/2017

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