Ryan M Ettner, LCSW-45249
Individual provider Active NPI Clinical Social Worker · Coeur D Alene, ID
NPI 1356005367 · NPPES record last updated Dec 19, 2025
Key facts
- NPI
- 1356005367
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 45249 (ID)
- Practice address
- 1875 N Lakewood Dr
Coeur D Alene, ID 83814-4928 - Phone
- (208) 771-7284
- NPI assigned
- Oct 26, 2021
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Mind Matters LLC
Practice addresses (Care Compare)
8382 N Wayne Dr
Suite 103B
Hayden, ID 83835-6028
Phone (208) 719-1030
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251209001827 | ID | Practitioner - Clinical Social Worker | 9931693843 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 45249 | ID | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mind Matters LLC | Current |
Accepting new patients | |
| Rathdrum Counseling Center, LLC | Clinical | Past |
Accepting new patients |
Locations
1875 N Lakewood Dr
Ste 101
Coeur D Alene, ID 83814
Phone (208) 667-3583
8382 N Wayne Dr
Ste 103B
Hayden, ID 83835
Phone (208) 635-5658
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 45249 | ID | Yes |
Addresses
Primary practice location
1875 N Lakewood Dr
Coeur D Alene, ID 83814-4928
Mailing address
1875 N Lakewood Dr
Coeur D Alene, ID 83814-4928
Phone (208) 771-7284
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437270097 | Other | ID | ALL PRIVATE INS UTILIZED |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | Rathdrum | Health Information Exchange (HIE) |
Other providers in Coeur D Alene, ID
- Eloy Espinoza
- Eric Estepp
- Julia Estes
- Luke Estes
- Etros Living, LLC
- Christine Evans
- Trenton James Evans
- Evenson Chiropractic, LLC
- Evergreen Dermatopathology LLC
- Kayla Everhart
All providers in Coeur D Alene, ID · Clinical Social Worker in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 19, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.