| Doctor Name: | JACK KETTERING |
| NPI Number: | 1043516925 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MA |
| License Number: | |
| Business Practice Address: | 930 W Hill Field Rd A Layton, UT - 840414662 |
| Business Phone Number: | 8013663040 |
| Business Fax Number: | |
| Mailing Address: | 899 Carter Dr, RIVERDALE |
| State: | UT |
| Postal Code: | 844052630 |
| Phone Number: | 4805430038 |
| Fax Number: | |
| NPI Enumeration Date: | 02/09/2011 |
| NPI Last Update Date: | 10/14/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |