Provider Demographics
NPI:1053920355
Name:PUERTO, DENISE
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:PUERTO
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 1:400 S SANTA FE AVE
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-4144
Mailing Address - Country:US
Mailing Address - Phone:785-452-4948
Mailing Address - Fax:
Practice Address - Street 1:730 HOLLY LN
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-8452
Practice Address - Country:US
Practice Address - Phone:785-452-4948
Practice Address - Fax:785-452-6119
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03007103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201308400AMedicaid