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General NPI Number Information
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NPI Number | 1003470121
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Entity Type | Individual
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Provider Name | DUSTYN RYAN PUTZIER LMSW
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Gender | Male
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Dates
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Enumeration Date | 04/24/2019
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Last Update Date | 06/06/2023
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Provider Practice Location Address
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Address Line | 51781 HUNTINGTON RD
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City | LA PINE
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State | OR
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Zip | 97739-1118
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Country | US
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Telephone | 541-907-7040
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Fax | 541-907-7059
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Provider Business Mailing Address
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Address Line | 11613 CABIN CREEK ST
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City | CALDWELL
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State | ID
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Zip | 83605-6793
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Country | US
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Telephone | 208-830-4503
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LMSW-35806
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License Number State | ID
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