Provider Demographics
NPI:1366822074
Name:KETOLA, JEANNE (MA LPCC)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:KETOLA
Suffix:
Gender:F
Credentials:MA LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4635 ORLEANS LN N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55442-2502
Mailing Address - Country:US
Mailing Address - Phone:612-810-7592
Mailing Address - Fax:
Practice Address - Street 1:8800 HIGHWAY 7
Practice Address - Street 2:SUITE 200
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55426-3908
Practice Address - Country:US
Practice Address - Phone:952-562-5733
Practice Address - Fax:952-548-8760
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN994101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional