Individual
RIVER KETCHERSIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
403 MUNICIPAL DR, CARTERVILLE, IL 62918-2042
(855) 608-3560
(618) 956-9349
Mailing address
915 N GRAND BLVD, SAINT LOUIS, MO 63106-1621
(314) 652-4100
(314) 845-5016
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
150109270
IL
Other
Enumeration date
10/29/2021
Last updated
06/13/2024
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