Ryan M Ettner, LCSW-45249

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

45249 Issued in ID

Practice address

1875 N Lakewood Dr
Coeur D Alene, ID 83814-4928

Phone

(208) 771-7284

NPI assigned

Oct 26, 2021

Last updated

Dec 19, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mind Matters LLCGroup PAC ID 5890106918, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mind Matters LLC

  • Multi-Specialty Clinic/Center
  • Coeur d'Alene, ID
  • NPI 1376160820
  Medicare reassignment Care Compare group NPD
• Rathdrum Counseling Center, LLC

  • Clinical Social Worker
  • Rathdrum, ID
  • NPI 1083152144
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1635206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1766102400000",
    "number": "1356005367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1875 N LAKEWOOD DR",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838144928",
            "telephone_number": "208-771-7284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1875 N LAKEWOOD DR",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838144928",
            "telephone_number": "208-771-7284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETTNER",
        "first_name": "RYAN",
        "middle_name": "M",
        "credential": "LCSW-45249",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-10-26",
        "last_updated": "2025-12-19",
        "certification_date": "2025-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "45249",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Rathdrum",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "14954 N Coeur Dalene St",
            "city": "Rathdrum",
            "state": "ID",
            "country_code": "US",
            "postal_code": "838586484",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Eloy Espinoza, MD, MPH
• Eric Estepp
• Julia Estes
• Luke Estes, CCP
• Etros Living, LLC
• Christine Evans
• Trenton James Evans, CRNA
• Evenson Chiropractic, LLC
• Evergreen Dermatopathology LLC
• Kayla Everhart, LCSW

• Clinical Social Worker in Coeur d'Alene, ID
• Providers in Coeur d'Alene, ID by specialty
• Clinical Social Worker in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.