Amanda Jean Putnam

Primary specialty

Social WorkerTaxonomy code 104100000X

License

1084-226 Issued in WI

Practice address

1791 County Highway Oo
Chippewa Falls, WI 54729-5347

Phone

(715) 797-2770

Fax

(715) 797-2770

NPI assigned

May 2, 2011

Last updated

Feb 9, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Miss Amanda Jean Alberts Former name

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Lakes Community Health Center IncGroup PAC ID 0840366654, 104 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• The Lakes Community Health Center, Inc

  dba NorthLakes Community Clinic

  • Federally Qualified Health Center (FQHC)
  • Iron River, WI
  • NPI 1811178825
  Medicare reassignment Care Compare group NPD
• Creative Healing Mental Health Center LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Chippewa Falls, WI
  • NPI 1346960366
  Medicare reassignment NPD
• The Lakes Community Health Center, Inc

  dba NorthLakes Community Clinic

  • Federally Qualified Health Center (FQHC)
  • White Lake, WI
  • NPI 1679983423
  NPD
• Innovative Counseling Inc

  • Community/Behavioral Health Agency
  • Green Bay, WI
  • NPI 1093869588
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1304294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707436800000",
    "number": "1528359080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1791 COUNTY HIGHWAY OO",
            "city": "CHIPPEWA FALLS",
            "state": "WI",
            "postal_code": "547295347",
            "telephone_number": "715-797-2770",
            "fax_number": "715-797-2770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1791 COUNTY HIGHWAY OO",
            "city": "CHIPPEWA FALLS",
            "state": "WI",
            "postal_code": "547295347",
            "telephone_number": "715-797-2770",
            "fax_number": "715-797-2770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUTNAM",
        "first_name": "AMANDA",
        "middle_name": "JEAN",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-05-02",
        "last_updated": "2024-02-09",
        "certification_date": "2024-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "WI",
            "license": "1084-226",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "ALBERTS",
            "middle_name": "JEAN",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Social Worker in Chippewa Falls, WI
• Providers in Chippewa Falls, WI by specialty
• Social Worker in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.