Provider Demographics
NPI:1699198697
Name:PUTT, MONICA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:PUTT
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 MURPHY CANYON RD STE 150
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4480
Mailing Address - Country:US
Mailing Address - Phone:619-275-4525
Mailing Address - Fax:619-275-4526
Practice Address - Street 1:5151 MURPHY CANYON RD STE 150
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4480
Practice Address - Country:US
Practice Address - Phone:619-275-4525
Practice Address - Fax:619-275-4526
Is Sole Proprietor?:No
Enumeration Date:2014-01-27
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9429235Z00000X
NY023259-1235Z00000X
CA27605235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist