Provider Demographics
NPI:1003470121
Name:PUTZIER, DUSTYN RYAN (LMSW)
Entity Type:Individual
Prefix:MR
First Name:DUSTYN
Middle Name:RYAN
Last Name:PUTZIER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11613 CABIN CREEK ST
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-6793
Mailing Address - Country:US
Mailing Address - Phone:208-830-4503
Mailing Address - Fax:
Practice Address - Street 1:51781 HUNTINGTON RD
Practice Address - Street 2:
Practice Address - City:LA PINE
Practice Address - State:OR
Practice Address - Zip Code:97739-1118
Practice Address - Country:US
Practice Address - Phone:541-907-7040
Practice Address - Fax:541-907-7059
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-24
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-358061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical