Individual
STEPHANIE M KETTL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, LPC
Contact information
Practice address
821 W PERSHING BLVD, CHEYENNE, WY 82001-2537
(307) 421-9329
(307) 635-3965
Mailing address
821 W PERSHING BLVD, CHEYENNE, WY 82001-2537
(307) 421-9329
(307) 635-3965
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
1017
WY
101YP2500X
Professional Counselor
Primary
1017
WY
Other
Enumeration date
09/21/2009
Last updated
07/22/2016
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