| Doctor Name: | NATHAN PUTNAM |
| NPI Number: | 1003265133 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MSW, CAPSW |
| License Number: | 130220-121 |
| Business Practice Address: | 612 N Randall Ave Janesville, WI - 535451958 |
| Business Phone Number: | 6087527660 |
| Business Fax Number: | 6087529788 |
| Mailing Address: | 612 N Randall Ave, JANESVILLE |
| State: | WI |
| Postal Code: | 535451958 |
| Phone Number: | 6087527660 |
| Fax Number: | 6087529788 |
| NPI Enumeration Date: | 06/09/2016 |
| NPI Last Update Date: | 06/09/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 130220-121 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |