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NPI Code Detail

MEDICARE: MRS. AMANDA JEAN PUTNAM

MEDICARE: MRS. AMANDA JEAN PUTNAM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker1084-226WI

General Provider Information

NPI Number : 1528359080
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. AMANDA JEAN PUTNAM
Provider Business Mailing Address
First Line : 1791 COUNTY HIGHWAY OO
Second Line :
City : CHIPPEWA FALLS
State : WI
Zip : 54729-5347
Country : US
Telephone Number : 715-797-2770
Fax Number : 715-797-2770
Provider Business Practice Location Address
First Line : 1791 COUNTY HIGHWAY OO
Second Line :
City : CHIPPEWA FALLS
State : WI
Zip : 54729-5347
Country : US
Telephone Number : 715-797-2770
Fax Number : 715-797-2770
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2011
Last Update Date : 02/09/2024

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Directions to “ MRS. AMANDA JEAN PUTNAM ” Practice Location

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