Individual
DR. PAUL W. KETTLEWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
100 N ACADEMY AVE, DANVILLE, PA 17822-1335
(570) 271-6516
Mailing address
100 N ACADEMY AVE, DANVILLE, PA 17822-4903
(570) 271-6144
(570) 271-6578
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS003794L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001675770
—
PA
05
—
067206
—
PA
Enumeration date
03/23/2006
Last updated
01/07/2021
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