Individual
MISS KRISTEN MARIE KETTENBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LMSW
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
2015036615
MO
133V00000X
Registered Dietitian
2009024338
MO
Other
Enumeration date
05/22/2010
Last updated
07/06/2021
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