Basic Information
| Provider Information | |||||||||
| NPI: | 1194803023 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KETTERING | ||||||||
| FirstName: | RHONDA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | MS, NCC,LPC.CAP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1322 JUNIPER DR | ||||||||
| Address2: | |||||||||
| City: | ROCK SPRINGS | ||||||||
| State: | WY | ||||||||
| PostalCode: | 829016409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3073526677 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2001 DEWAR DR | ||||||||
| Address2: | SUITE 270 | ||||||||
| City: | ROCK SPRINGS | ||||||||
| State: | WY | ||||||||
| PostalCode: | 829015773 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3073823058 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 06/06/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 071 | WY | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | 970 | WY | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.