Active NPI
Page Lyn Erntson, LCSW
- Social Worker
- Fruitland, ID
National Provider Identifier
1073399259
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- LCSW-8911438
- Practice address
- 1100 NW 12TH St
Fruitland, ID 83619-5040 - Phone
- (208) 452-6556
- NPI assigned
- Sep 5, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | LCSW-8911438 | ID | Primary |
Addresses
Primary practice location
1100 NW 12TH St
Fruitland, ID 83619-5040
Mailing address
1100 NW 12TH St
Fruitland, ID 83619-5040
Phone (208) 452-6556
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCSW-8911438 | ID | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1693872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1759276800000",
"number": "1073399259",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1100 NW 12TH ST",
"city": "FRUITLAND",
"state": "ID",
"postal_code": "836195040",
"telephone_number": "208-452-6556"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1100 NW 12TH ST",
"city": "FRUITLAND",
"state": "ID",
"postal_code": "836195040",
"telephone_number": "208-452-6556"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ERNTSON",
"first_name": "PAGE",
"middle_name": "LYN",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-09-05",
"last_updated": "2025-10-01",
"certification_date": "2025-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "ID",
"license": "LCSW-8911438",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fruitland, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.