Provider Demographics
NPI:1689395790
Name:KETTERING, JENIFER NICOLE
Entity Type:Individual
Prefix:
First Name:JENIFER
Middle Name:NICOLE
Last Name:KETTERING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7363 W 26TH PL
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-8011
Mailing Address - Country:US
Mailing Address - Phone:614-353-8779
Mailing Address - Fax:
Practice Address - Street 1:7363 W 26TH PL
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-8011
Practice Address - Country:US
Practice Address - Phone:614-353-8779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
No385H00000XRespite Care FacilityRespite Care