Provider Demographics
NPI:1801434584
Name:PUTNAM, JENNIFER M (AMFT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:PUTNAM
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:M
Other - Last Name:PUTNAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFTI
Mailing Address - Street 1:340 E 600 S
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3949
Mailing Address - Country:US
Mailing Address - Phone:435-228-9092
Mailing Address - Fax:
Practice Address - Street 1:321 NORTH MALL DRIVE
Practice Address - Street 2:VW103
Practice Address - City:ST. GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790
Practice Address - Country:US
Practice Address - Phone:435-225-6367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist