Jan E Ketterling, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

MN LP 4296 Issued in MN

Practice address

2400 St Francis Drive
Hope Unit St Francis Medical Center
Breckenridge, MN 56520

Phone

(218) 643-0499

NPI assigned

Mar 6, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• St. Francis Medical Center

  dba Chi St Francis Health

  • Rural Health Clinic/Center
  • Milnor, ND
  • NPI 1235215252
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1063542371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17975 79TH ST SE",
            "city": "WAHPETON",
            "state": "ND",
            "postal_code": "58075",
            "telephone_number": "701-642-6655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 ST FRANCIS DRIVE",
            "address_2": "HOPE UNIT ST FRANCIS MEDICAL CENTER",
            "city": "BRECKENRIDGE",
            "state": "MN",
            "postal_code": "56520",
            "telephone_number": "218-643-0499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETTERLING",
        "first_name": "JAN",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "MN LP 4296",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BHSI",
            "identifier": "056M4KE",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NDMA",
            "identifier": "11882",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gwen Humann, PT
• Intuitive Touch Massge
• Denise Rita Jelinek, PT
• Taylor Karger, PT, DPT
• Laurie Jo Ann Kessler, MS LAC
• Jason C Kjar, O.T.
• Scott J Kompelien, PHARM D.
• Shawn Marie Krause Roberts, PT
• Jessica Lynn Kurth
• Kaylen Kvidt, PT, DPT, ATC

• Clinical Psychologist in Breckenridge, MN
• Providers in Breckenridge, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.