Provider Demographics
NPI:1457681538
Name:PUTNAM, KATHLEEN (MS, RD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:PUTNAM
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 NE BLAKELEY ST STE 3B
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-3168
Mailing Address - Country:US
Mailing Address - Phone:206-729-2633
Mailing Address - Fax:206-729-2636
Practice Address - Street 1:2901 NE BLAKELEY ST STE 3B
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3168
Practice Address - Country:US
Practice Address - Phone:206-729-2633
Practice Address - Fax:206-729-2636
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00000689133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered