Individual
MS. SUSAN KETTLEWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
610 N 2ND AVE, TUCSON, AZ 85705-7802
(520) 624-4931
Mailing address
610 N 2ND AVE, TUCSON, AZ 85705-7802
(520) 624-4931
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
—
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
194132
—
AZ
Enumeration date
04/11/2007
Last updated
07/26/2007
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