Provider Demographics
NPI:1528359080
Name:PUTNAM, AMANDA JEAN
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:JEAN
Last Name:PUTNAM
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:JEAN
Other - Last Name:ALBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1791 COUNTY HIGHWAY OO
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-5347
Mailing Address - Country:US
Mailing Address - Phone:715-797-2770
Mailing Address - Fax:715-797-2770
Practice Address - Street 1:1791 COUNTY HIGHWAY OO
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-5347
Practice Address - Country:US
Practice Address - Phone:715-797-2770
Practice Address - Fax:715-797-2770
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1084-226104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker