Provider Demographics
NPI:1093974966
Name:KETTERING, DAISY CATHERINE (IMF)
Entity Type:Individual
Prefix:MISS
First Name:DAISY
Middle Name:CATHERINE
Last Name:KETTERING
Suffix:
Gender:F
Credentials:IMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6160 MISSION GORGE RD
Mailing Address - Street 2:200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-3410
Mailing Address - Country:US
Mailing Address - Phone:619-281-3706
Mailing Address - Fax:619-281-3714
Practice Address - Street 1:6160 MISSION GORGE RD
Practice Address - Street 2:200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-3410
Practice Address - Country:US
Practice Address - Phone:619-281-3706
Practice Address - Fax:619-281-3714
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor