Provider Demographics
NPI:1679622583
Name:KESSELRING, JOHN WALTER (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WALTER
Last Name:KESSELRING
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:175 S FRANKLIN ST
Mailing Address - Street 2:SUITE 318
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-1321
Mailing Address - Country:US
Mailing Address - Phone:907-463-4141
Mailing Address - Fax:907-463-4545
Practice Address - Street 1:175 S FRANKLIN ST
Practice Address - Street 2:SUITE 318
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-1321
Practice Address - Country:US
Practice Address - Phone:907-463-4141
Practice Address - Fax:907-463-4545
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK329103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical