Basic Information
| Provider Information | |||||||||
| NPI: | 1801049713 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PUTERSKI | ||||||||
| FirstName: | EILEEN | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8800 SE SUNNYSIDE RD STE 300N | ||||||||
| Address2: | |||||||||
| City: | CLACKAMAS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970155703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812862999 | ||||||||
| FaxNumber: | 5126074893 | ||||||||
| Practice Location | |||||||||
| Address1: | 2911 CHAPEL HILL RD STE 145 | ||||||||
| Address2: | |||||||||
| City: | DOUGLASVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301357163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7705776739 | ||||||||
| FaxNumber: | 7705776743 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2008 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | AU 57 | NV | N | Speech, Language and Hearing Service Providers | Audiologist | 237600000X | HA149 | NV | N | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | 237700000X | GA | N | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist | 237600000X | GA | Y | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
No ID Information.