Healthcare Provider Details

I. General information

NPI: 1265855282
Provider Name (Legal Business Name): SARA KATE PUTNAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARA KATE LEGGITT

II. Dates (important events)

Enumeration Date: 01/27/2014
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 STUBBS AVE
MONROE LA
71201-5629
US

IV. Provider business mailing address

1605 STUBBS AVE
MONROE LA
71201-5629
US

V. Phone/Fax

Practice location:
  • Phone: 318-388-8414
  • Fax: 318-388-8558
Mailing address:
  • Phone: 183-388-8414
  • Fax: 318-388-8558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number6909
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: