Provider Demographics
NPI:1053640946
Name:KETCHUM, JENNIFER S (CMT)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:S
Last Name:KETCHUM
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 CARMANWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-5503
Mailing Address - Country:US
Mailing Address - Phone:810-429-1491
Mailing Address - Fax:
Practice Address - Street 1:5383 PINEWOOD DR
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:MI
Practice Address - Zip Code:48433-2439
Practice Address - Country:US
Practice Address - Phone:810-252-9291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath