Provider Demographics
NPI:1265402952
Name:KETNER, ELAINE (MA,CCC-A)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:KETNER
Suffix:
Gender:F
Credentials:MA,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 CALIFORNIA STREET
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201
Mailing Address - Country:US
Mailing Address - Phone:812-376-6593
Mailing Address - Fax:812-375-9368
Practice Address - Street 1:1202 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-5841
Practice Address - Country:US
Practice Address - Phone:812-376-6593
Practice Address - Fax:812-375-9368
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23001876A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist