Healthcare Provider Details
I. General information
NPI: 1265975197
Provider Name (Legal Business Name): KATHARINE M PUTMAN LP
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 11/26/2016
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1300 E BRADFORD PKWY
SPRINGFIELD MO
65804-4264
US
IV. Provider business mailing address
PO BOX 844715
KANSAS CITY MO
64184-4715
US
V. Phone/Fax
- Phone: 417-761-5000
- Fax: 417-761-5011
- Phone: 417-761-5214
- Fax: 417-761-5065
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 103TC0700X |
| Taxonomy | Clinical Psychologist |
| License Number | 2022044418 |
| License Number State | MO |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: