Individual
JOHN THOMAS KETTLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CSAC, LPC-IT
Contact information
Practice address
500 RIVERVIEW AVE, WAUKESHA, WI 53188-3632
(262) 548-7666
(262) 548-7656
Mailing address
500 RIVERVIEW AVE, WAUKESHA, WI 53188-3632
(262) 548-7666
(262) 548-7656
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
15594-132
WI
101YP2500X
Professional Counselor
1016-226
WI
Other
Enumeration date
12/24/2009
Last updated
10/20/2011
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