Provider Demographics
NPI:1295886588
Name:PUTMAN, COILLE A (MS)
Entity type:Individual
Prefix:MS
First Name:COILLE
Middle Name:A
Last Name:PUTMAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:COILLE
Other - Middle Name:A
Other - Last Name:SHANER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:DEWIT RITECARE SPEECH, LANGUAGE, & HEARING CLINIC SCHOO
Mailing Address - Street 2:32 CAMPUS DR
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59812-6695
Mailing Address - Country:US
Mailing Address - Phone:406-243-2405
Mailing Address - Fax:406-243-6678
Practice Address - Street 1:425 N 30TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2100
Practice Address - Country:US
Practice Address - Phone:402-452-5000
Practice Address - Fax:402-452-5028
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8110235Z00000X
NE613235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100251772-00Medicaid
NE06553OtherBCBS ENT
NE100252727-00Medicaid
NE100251783-00Medicaid
NE100251782-00Medicaid
NE06548OtherBCBS BT