Active NPI
John Thomas Kettler, CSAC, LPC-IT
- Addiction (Substance Use Disorder) Counselor
- Waukesha, WI
National Provider Identifier
1912236845
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 15594-132
- Practice address
- 500 Riverview Ave
Waukesha, WI 53188-3632 - Phone
- (262) 548-7666
- Fax
- (262) 548-7656
- NPI assigned
- Dec 24, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 1016-226 | WI | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 15594-132 | WI | Primary |
Addresses
Primary practice location
500 Riverview Ave
Waukesha, WI 53188-3632
Mailing address
500 Riverview Ave
Waukesha, WI 53188-3632
Phone (262) 548-7666
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15594-132 | WI | MD | Addiction (Substance Use Disorder) Counselor |
| 1016-226 | WI | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1261612800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1319068800000",
"number": "1912236845",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 RIVERVIEW AVE",
"city": "WAUKESHA",
"state": "WI",
"postal_code": "531883632",
"telephone_number": "262-548-7666",
"fax_number": "262-548-7656"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 RIVERVIEW AVE",
"city": "WAUKESHA",
"state": "WI",
"postal_code": "531883632",
"telephone_number": "262-548-7666",
"fax_number": "262-548-7656"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KETTLER",
"first_name": "JOHN",
"middle_name": "THOMAS",
"credential": "CSAC, LPC-IT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-12-24",
"last_updated": "2011-10-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "WI",
"license": "1016-226",
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "WI",
"license": "15594-132",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waukesha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.