Provider Demographics
NPI:1003423948
Name:PUTNAM, JASMIN S (RBT)
Entity Type:Individual
Prefix:
First Name:JASMIN
Middle Name:S
Last Name:PUTNAM
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:583 WINDSONG WAY
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-9122
Mailing Address - Country:US
Mailing Address - Phone:505-603-2744
Mailing Address - Fax:
Practice Address - Street 1:3709 CITATION WAY STE 102
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-9022
Practice Address - Country:US
Practice Address - Phone:541-500-6532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty