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1508581794
DERIC RYAN KETTWIG
COSTA MESA, CA
NPI
1508581794
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
106S00000X Behavior Technician
Enumeration Date
2022-10-10
Last Update Date
2022-10-10
Business Address
DERIC RYAN KETTWIG
3151 AIRWAY AVE STE P3
COSTA MESA, CA 92626-4626
Phone number: 949-694-7172
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Mailing Address
DERIC RYAN KETTWIG
378 N 475 W
VALPARAISO, IN 46385-9228
Phone number: 317-496-5287
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