Healthcare Provider Details

I. General information

NPI: 1568214823
Provider Name (Legal Business Name): EMILY ANN PUTNAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2024
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20104 ARSENAL STREET RD
WATERTOWN NY
13601-5555
US

IV. Provider business mailing address

40540 CROSS RD
THERESA NY
13691-2024
US

V. Phone/Fax

Practice location:
  • Phone: 315-779-7000
  • Fax:
Mailing address:
  • Phone: 518-645-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: