Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 01624 | IA |
NPI | 1003073925 |
---|---|
Provider Name | Carol Putz |
First Address | Ames, IA 50010-0224 |
Second Address | Ames, IA 50010-3309 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2008 |
Last Update Date | 19/05/2008 |