Individual
KELLY DAE KETTLEWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
49 E 4TH ST STE 205, WILLIAMSPORT, PA 17701-6355
(570) 601-4788
Mailing address
49 E 4TH ST STE 205, WILLIAMSPORT, PA 17701-6355
(570) 601-4788
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
PS017216
PA
Other
Enumeration date
02/15/2022
Last updated
02/08/2023
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