NPIMap

Individual provider Active NPI

Jennifer Rian Tuttle, LCSW

  • Clinical Social Worker
  • Hayden, ID
National Provider Identifier
1609158781
Registry record updated Sep 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
31649 Issued in ID
Practice address
9705 N Shaw St
Hayden, ID 83835-9716
Phone
(208) 625-9981
NPI assigned
Sep 14, 2011
Last updated
Sep 5, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LCSW-31649 ID
Clinical Social Worker 1041C0700X 31649 ID Primary

Addresses

Primary practice location

9705 N Shaw St
Hayden, ID 83835-9716

Mailing address

9705 N Shaw St
Hayden, ID 83835-9716
Phone (208) 625-9981

Other identifiers 1

IdentifierTypeStateIssuer
1609158781MedicaidID

Other names 1

  • Jennifer Rian McLuskie Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
31649IDMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Pathways of Idaho, LLC Past Accepting new patients
Hemisphere Health PLLC Past Accepting new patients
Lake City Counseling Center PastSince Aug 7, 2016 Accepting new patients
Alliance Family Services Past Accepting new patients
Praxis Health, PC Past Accepting new patients
Lake City Counseling Center PastSince Aug 7, 2016 Accepting new patients
Lake City Counseling Center PastSince Aug 7, 2016 Accepting new patients

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1315958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567641600000",
    "number": "1609158781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9705 N SHAW ST",
            "city": "HAYDEN",
            "state": "ID",
            "postal_code": "838359716",
            "telephone_number": "208-625-9981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9705 N SHAW ST",
            "city": "HAYDEN",
            "state": "ID",
            "postal_code": "838359716",
            "telephone_number": "208-625-9981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUTTLE",
        "first_name": "JENNIFER",
        "middle_name": "RIAN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-14",
        "last_updated": "2019-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "LCSW-31649",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "31649",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1609158781",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "MCLUSKIE",
            "middle_name": "RIAN",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Hayden, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.