Provider Demographics
NPI:1891557997
Name:KETTENRING, DEANN ELLSWORTH (ACMHC)
Entity Type:Individual
Prefix:
First Name:DEANN
Middle Name:ELLSWORTH
Last Name:KETTENRING
Suffix:
Gender:F
Credentials:ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 W MEDICAL DR STE 1
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-3191
Mailing Address - Country:US
Mailing Address - Phone:801-955-3600
Mailing Address - Fax:801-955-3600
Practice Address - Street 1:104 W MEDICAL DR STE 1
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:UT
Practice Address - Zip Code:84045-3191
Practice Address - Country:US
Practice Address - Phone:801-955-3600
Practice Address - Fax:801-955-3600
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9152364-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health