Healthcare Provider Details

I. General information

NPI: 1003743543
Provider Name (Legal Business Name): LISANDRA PUTNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 OLD FARM RD
BAKERSFIELD CA
93312-5467
US

IV. Provider business mailing address

8900 BEAR CREEK RD
BAKERSFIELD CA
93311-2505
US

V. Phone/Fax

Practice location:
  • Phone: 661-588-6065
  • Fax:
Mailing address:
  • Phone: 661-332-2701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number28853
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: