Healthcare Provider Details

I. General information

NPI: 1457681538
Provider Name (Legal Business Name): KATHLEEN PUTNAM M.S., R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2010
Last Update Date: 01/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 NE BLAKELEY ST STE 3B
SEATTLE WA
98105-3168
US

IV. Provider business mailing address

2901 NE BLAKELEY ST STE 3B
SEATTLE WA
98105-3168
US

V. Phone/Fax

Practice location:
  • Phone: 206-729-2633
  • Fax: 206-729-2636
Mailing address:
  • Phone: 206-729-2633
  • Fax: 206-729-2636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI00000689
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: