Basic Information
| Provider Information | |||||||||
| NPI: | 1578701041 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KETTMANN | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1150 VETERANS BLVD | ||||||||
| Address2: | DEPARTMENT OF PSYCHIATRY | ||||||||
| City: | REDWOOD CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940632037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6502994764 | ||||||||
| FaxNumber: | 6502994335 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 VETERANS BLVD | ||||||||
| Address2: | DEPARTMENT OF PSYCHIARTY | ||||||||
| City: | REDWOOD CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940632612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6502994764 | ||||||||
| FaxNumber: | 6502994335 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/21/2009 | ||||||||
| LastUpdateDate: | 12/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PSY22182 | CA | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.