Individual
SUSAN L KETTLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSSW, LCSW
Contact information
Practice address
10475 STATE ROAD 27, HAYWARD, WI 54843-2000
(715) 934-3677
(715) 934-3676
Mailing address
10475 STATE ROAD 27, SUITE 300, HAYWARD, WI 54843-2000
(715) 934-3677
(715) 934-3676
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
13070
WI
1041C0700X
Clinical Social Worker
Primary
7159-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40992100
—
WI
Enumeration date
05/23/2007
Last updated
02/07/2011
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