Individual
HEATHER MARIE KETTERLING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS CCC-SLP
Contact information
Practice address
8100 PENN AVE S STE 169, MINNEAPOLIS, MN 55431-1325
(612) 216-3527
(612) 216-2727
Mailing address
8100 PENN AVE S STE 169, MINNEAPOLIS, MN 55431-1325
(612) 216-3527
(612) 216-2727
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7265
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
211G2KE
BLUE CROSS BLUE SHIELD
MN
01
—
4600884
MEDICA
MN
Enumeration date
01/18/2007
Last updated
06/21/2024
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