| Randy L. Kettering Phd, Pc | |
|
807 Davis St Unit 605 Evanston IL 60201-4820 | |
| (847) 934-8475 | |
| Not Available |
| Full Name | Randy L. Kettering Phd, Pc |
|---|---|
| Speciality | Psychologist |
| Location | 807 Davis St Unit 605, Evanston, Illinois |
| Authorized Official Name and Position | Randy Lee Kettering (PRESIDENT) |
| Authorized Official Contact | 8479348475 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Randy L. Kettering Phd, Pc 807 Davis St Unit 605 Evanston IL 60201-4820 Ph: (847) 934-8475 | Randy L. Kettering Phd, Pc 807 Davis St Unit 605 Evanston IL 60201-4820 Ph: (847) 934-8475 |
| NPI Number | 1194937359 |
|---|---|
| Provider Enumeration Date | 05/03/2007 |
| Last Update Date | 10/06/2022 |
| Certification Date | 10/06/2022 |
| Medicare PECOS PAC ID | 4880779586 |
|---|---|
| Medicare Enrollment ID | O20080305000264 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194937359 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 060004613 (Illinois) | Primary |
| Provider Name | Randy L Kettering |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1407849680 PECOS PAC ID: 3072698778 Enrollment ID: I20080305000252 |
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