Healthcare Provider Details

I. General information

NPI: 1699363309
Provider Name (Legal Business Name): KAYLA R PUTZKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2021
Last Update Date: 09/11/2025
Certification Date: 11/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 LABREE AVE S
THIEF RIVER FALLS MN
56701-2819
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 218-683-4351
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: