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General NPI Number Information
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NPI Number | 1689278400
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Entity Type | Individual
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Provider Name | MS. HALEY MARYN PUTIN
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Gender | Female
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Dates
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Enumeration Date | 11/23/2020
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Last Update Date | 10/22/2025
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Provider Practice Location Address
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Address Line | 5359 NOBEL DR UNIT 211
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City | FITCHBURG
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State | WI
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Zip | 53711-4977
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Country | US
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Telephone | 608-527-0929
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Fax |
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Provider Business Mailing Address
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Address Line | 5359 NOBEL DR UNIT 211
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City | FITCHBURG
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State | WI
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Zip | 53711-4977
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Country | US
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Telephone |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 135851-121
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6851116161
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License Number State | MI
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