Basic Information
| Provider Information | |||||||||
| NPI: | 1720666514 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PUTNAM | ||||||||
| FirstName: | HANNAH | ||||||||
| MiddleName: | MAE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 107 FRAZIER CT STE 1C | ||||||||
| Address2: | |||||||||
| City: | GEORGETOWN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403249026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8595238796 | ||||||||
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| Practice Location | |||||||||
| Address1: | 107 FRAZIER CT STE 1C | ||||||||
| Address2: | |||||||||
| City: | GEORGETOWN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403249026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8595238796 | ||||||||
| FaxNumber: | 8595239426 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2021 | ||||||||
| LastUpdateDate: | 04/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | 266338 | KY | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.