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IAN FETTEROLF MA, MSW
NPI 1043736358
Student in an Organized Health Care Education/Training Program in La Jolla, CA

Active since August 17, 2017
7777 FAY AVE STE 205, LA JOLLA, CA 92037(415) 646-4506 Get Directions Write a Review

NPPES record last updated: July 21, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jul 21, 2022, May 5, 2022, Aug 17, 2017 (3 updates tracked since 2017).

About Ian Fetterolf Ma, Msw NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

IAN FETTEROLF MA, MSW (NPI 1043736358) is an individual student in an organized health care education/training program in La Jolla, California and active in the NPI registry since August 2017. He maintains 2 additional practice locations.

NPPES Registry Identity

NPI1043736358
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameIAN FETTEROLFCredential: MA, MSW
Location Address7777 FAY AVE STE 205La Jolla, CA 92037-4324
Mailing Address912 Cole St # 368San Francisco, CA 94117-4316 · (814) 279-1806
Phone(415) 646-4506
Sole ProprietorNo
Enumeration DateAugust 17, 2017
Last NPPES UpdateJuly 21, 20223 updates tracked since enumeration
NPPES CertifiedApril 23, 2022
✔ NPI 1043736358 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
7777 FAY AVE STE 205, La Jolla, CA 92037
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Secondary Practice Locations 2

Location 1777 Fay Avenue, Suite #205La Jolla, CA 92037 · Phone (415) 646-4506
Location 21436 Goodrich BlvdCommerce, CA 90022-5111 · Phone (323) 832-9795

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MELINDA WONG CONOLLY PSYD
Psychologist (Clinical)
7777 FAY AVE STE 205
LA JOLLA, CA 92037
San Diego County (415) 971-1820
MS. LADERA NICOLE PEREZ LINN PSYD
Psychologist (Clinical)
7777 FAY AVE STE 205
LA JOLLA, CA 92037
San Diego County (628) 253-1889
DR. NICOLE MARIE KARST CAMLIN PSYD
Psychologist (Forensic)
7777 FAY AVE STE 205
LA JOLLA, CA 92037
San Diego County (760) 586-5832
GALINA BUCKHOUT PSY.D.
Counselor (Professional)
7777 FAY AVE STE 205
LA JOLLA, CA 92037
San Diego County (415) 843-1523

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ian Fetterolf's NPI number?

The NPI number for Ian Fetterolf is 1043736358. It was assigned to this individual provider in the NPPES registry on August 17, 2017.

Where is Ian Fetterolf located?

Ian Fetterolf practices at 7777 Fay Ave Ste 205, La Jolla, CA 92037. The listed phone number is (415) 646-4506.

What is Ian Fetterolf's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

When was this NPI record last updated?

The NPPES record for Ian Fetterolf was last updated on July 21, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.