Active NPI
Stephanie M Kettl, MS, LPC
- Professional Counselor
- Cheyenne, WY
National Provider Identifier
1982938114
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 1017
- Practice address
- 821 W Pershing Blvd
Cheyenne, WY 82001-2537 - Phone
- (307) 421-9329
- Fax
- (307) 635-3965
- NPI assigned
- Sep 21, 2009
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | 1017 | WY | |
| Professional Counselor | 101YP2500X | 1017 | WY | Primary |
Addresses
Primary practice location
821 W Pershing Blvd
Cheyenne, WY 82001-2537
Mailing address
821 W Pershing Blvd
Cheyenne, WY 82001-2537
Phone (307) 421-9329
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)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1017 | WY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1253491200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1469145600000",
"number": "1982938114",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "821 W PERSHING BLVD",
"city": "CHEYENNE",
"state": "WY",
"postal_code": "820012537",
"telephone_number": "307-421-9329",
"fax_number": "307-635-3965"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "821 W PERSHING BLVD",
"city": "CHEYENNE",
"state": "WY",
"postal_code": "820012537",
"telephone_number": "307-421-9329",
"fax_number": "307-635-3965"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KETTL",
"first_name": "STEPHANIE",
"middle_name": "M",
"credential": "MS, LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-09-21",
"last_updated": "2016-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "WY",
"license": "1017",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "WY",
"license": "1017",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cheyenne, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.