Provider Demographics
NPI:1740027408
Name:PUTNAM, CASSIDY MARIE
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:MARIE
Last Name:PUTNAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CASSIDY
Other - Middle Name:MARIE
Other - Last Name:MOON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18228 E 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:WA
Mailing Address - Zip Code:99016-8803
Mailing Address - Country:US
Mailing Address - Phone:509-723-6061
Mailing Address - Fax:
Practice Address - Street 1:18228 E 12TH AVE
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:WA
Practice Address - Zip Code:99016-8803
Practice Address - Country:US
Practice Address - Phone:509-723-6061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral