Individual
JENNIFER W. PUTNAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S. CCC-SLP
Contact information
Practice address
3145 DARTAGNAN DR, POCATELLO, ID 83204-5090
(208) 520-1403
(208) 232-2766
Mailing address
3145 DARTAGNAN DR, POCATELLO, ID 83204-5090
(208) 520-1403
(208) 232-2766
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP-1405
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010145355
REGENCE BLUE SHIELD OF ID
ID
01
—
12012396
NATIONAL ASHA NUMBER
ID
01
—
SLP-1405
STATE LICENSE NUMBER
ID
01
—
SPL10
BLUE CROSS OF IDAHO
ID
Enumeration date
12/13/2006
Last updated
03/07/2012
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