Organization
RANDY L. KETTERING PHD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDY LEE KETTERING PH.D. (PRESIDENT)
(847) 934-8475
Entity
Organization
Contact information
Practice address
807 DAVIS ST UNIT 605, EVANSTON, IL 60201-4820
(847) 934-8475
Mailing address
807 DAVIS ST UNIT 605, EVANSTON, IL 60201-4820
(847) 934-8475
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
060004613
IL
Other
Enumeration date
05/03/2007
Last updated
10/06/2022
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