Provider Demographics
NPI:1225654809
Name:PUTT PEDIATRIC SPEECH AND LANGUAGE THERAPY, LLC
Entity Type:Organization
Organization Name:PUTT PEDIATRIC SPEECH AND LANGUAGE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST, CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAITLIN
Authorized Official - Middle Name:HELENE
Authorized Official - Last Name:PUTT
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:574-387-3567
Mailing Address - Street 1:57657 BOULDER CT
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46528-7860
Mailing Address - Country:US
Mailing Address - Phone:574-849-0037
Mailing Address - Fax:574-807-9564
Practice Address - Street 1:57657 BOULDER CT
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46528-7860
Practice Address - Country:US
Practice Address - Phone:574-849-0037
Practice Address - Fax:574-807-9564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty