| Doctor Name: | MICHAEL KETTNER |
| NPI Number: | 1417224536 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LADC |
| License Number: | 301312 |
| Business Practice Address: | 43500 Migizi Dr Onamia, MN - 563592241 |
| Business Phone Number: | 3205324163 |
| Business Fax Number: | 3205327542 |
| Mailing Address: | 502 Weber Ave #201, HINCKLEY |
| State: | MN |
| Postal Code: | 55037 |
| Phone Number: | 3203846696 |
| Fax Number: | 3203840020 |
| NPI Enumeration Date: | 11/17/2011 |
| NPI Last Update Date: | 11/17/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 301312 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |