Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 9024-123 | WI |
NPI | 1003265133 |
---|---|
Provider Name | Nathan Putnam |
First Address | Janesville, WI 53545-1958 |
Second Address | Janesville, WI 53545-1958 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2016 |
Last Update Date | 03/10/2018 |