Individual
DR. JAN E KETTERLING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
2400 ST FRANCIS DRIVE, HOPE UNIT ST FRANCIS MEDICAL CENTER, BRECKENRIDGE, MN 56520
(218) 643-0499
Mailing address
17975 79TH ST SE, WAHPETON, ND 58075
(701) 642-6655
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
MN LP 4296
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
056M4KE
BHSI
—
01
—
11882
NDMA
—
Enumeration date
03/06/2007
Last updated
07/08/2007
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