Doctor Name: | DR. JAN E KETTERLING |
NPI Number: | 1063542371 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PSYD |
License Number: | MN LP 4296 |
Business Practice Address: | 2400 St Francis Drive Hope Unit St Francis Medical Center Breckenridge, MN - 56520 |
Business Phone Number: | 2186430499 |
Business Fax Number: | |
Mailing Address: | 17975 79th St Se, WAHPETON |
State: | ND |
Postal Code: | 58075 |
Phone Number: | 7016426655 |
Fax Number: | |
NPI Enumeration Date: | 03/06/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | MN LP 4296 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |