Provider Demographics
NPI:1467941500
Name:PUTZ, ALEXANDER (RBT)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:PUTZ
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 WEST 163RD ST
Mailing Address - Street 2:
Mailing Address - City:MARKHAM
Mailing Address - State:IL
Mailing Address - Zip Code:60428
Mailing Address - Country:US
Mailing Address - Phone:708-210-2888
Mailing Address - Fax:
Practice Address - Street 1:3015 WEST 163RD ST
Practice Address - Street 2:
Practice Address - City:MARKHAM
Practice Address - State:IL
Practice Address - Zip Code:60428
Practice Address - Country:US
Practice Address - Phone:708-210-2888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-03
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1192180235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist