Provider Demographics
NPI:1790983468
Name:KETTMANN, LINDA SUE (MA, NCC, PLPC)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:SUE
Last Name:KETTMANN
Suffix:
Gender:F
Credentials:MA, NCC, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12230 MEADE DR
Mailing Address - Street 2:
Mailing Address - City:WRIGHT CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63390-3955
Mailing Address - Country:US
Mailing Address - Phone:636-795-3714
Mailing Address - Fax:
Practice Address - Street 1:201 NORTH CHERRY ST
Practice Address - Street 2:
Practice Address - City:WRIGHT CITY
Practice Address - State:MO
Practice Address - Zip Code:63390-1130
Practice Address - Country:US
Practice Address - Phone:636-745-7880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006033179101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor