Provider Demographics
NPI:1003265133
Name:PUTNAM, NATHAN (MSW, CAPSW)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:PUTNAM
Suffix:
Gender:M
Credentials:MSW, CAPSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 N RANDALL AVE
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-1958
Mailing Address - Country:US
Mailing Address - Phone:608-752-7660
Mailing Address - Fax:608-752-9788
Practice Address - Street 1:612 N RANDALL AVE
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-1958
Practice Address - Country:US
Practice Address - Phone:608-752-7660
Practice Address - Fax:608-752-9788
Is Sole Proprietor?:No
Enumeration Date:2016-06-09
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9024-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical