Provider Demographics
NPI:1265855282
Name:PUTNAM, SARA KATE
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:KATE
Last Name:PUTNAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:KATE
Other - Last Name:LEGGITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1605 STUBBS AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-5629
Mailing Address - Country:US
Mailing Address - Phone:183-388-8414
Mailing Address - Fax:318-388-8558
Practice Address - Street 1:1605 STUBBS AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5629
Practice Address - Country:US
Practice Address - Phone:318-388-8414
Practice Address - Fax:318-388-8558
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6909235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2409620Medicaid
LA478619YJBUMedicare PIN