Randy Lee Kettering, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071003300 Issued in IL

Practice address

11 W College Dr
Suite B
Arlington Heights, IL 60004-1900

Phone

(847) 934-8475

Fax

(847) 934-8475

NPI assigned

Aug 24, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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

{
    "created_epoch": "1124841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1206662400000",
    "number": "1407849680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 W COLLEGE DR",
            "address_2": "SUITE B",
            "city": "ARLINGTON HEIGHTS",
            "state": "IL",
            "postal_code": "600041900",
            "telephone_number": "847-934-8475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 W COLLEGE DR",
            "address_2": "SUITE B",
            "city": "ARLINGTON HEIGHTS",
            "state": "IL",
            "postal_code": "600041900",
            "telephone_number": "847-934-8475",
            "fax_number": "847-934-8475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETTERING",
        "first_name": "RANDY",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-24",
        "last_updated": "2008-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071003300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Arlington Heights, IL
• Providers in Arlington Heights, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2008; 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.