Healthcare Provider Details

I. General information

NPI: 1033996475
Provider Name (Legal Business Name): ALEXA D PUTNAM MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 OAKLAND AVE
ELKHART IN
46517-1597
US

IV. Provider business mailing address

PO BOX 809
GOSHEN IN
46527-0809
US

V. Phone/Fax

Practice location:
  • Phone: 574-533-1234
  • Fax: 574-537-2652
Mailing address:
  • Phone: 574-533-1234
  • Fax: 574-537-2652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: