Provider Demographics
NPI:1447083340
Name:VANDERPUTTEN, MARILYN
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:VANDERPUTTEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 PORTER ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:KS
Mailing Address - Zip Code:66402-9459
Mailing Address - Country:US
Mailing Address - Phone:785-207-4567
Mailing Address - Fax:
Practice Address - Street 1:1106 N 155TH ST STE B
Practice Address - Street 2:
Practice Address - City:BASEHOR
Practice Address - State:KS
Practice Address - Zip Code:66007-7100
Practice Address - Country:US
Practice Address - Phone:785-256-9096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician