Traci Alene Kettle

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

4694 Issued in ID

Practice address

211 S Woodruff Ave Ste A3
Idaho Falls, ID 83401-4865

Phone

(208) 524-4818

NPI assigned

Jan 9, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Marriage and Family Therapist

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Willow Sage Services LLCGroup PAC ID 8527341007, 4 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 and National Provider Directory roles.

• Willow Sage Services LLC

  • Counselor
  • Idaho Falls, ID
  • NPI 1538611652

  Marriage & Family Therapist

  Medicare reassignment Care Compare group NPD
• Alliance Home Health of Idaho, LLC

  • Community Based Hospice Care Agency
  • Twin Falls, ID
  • NPI 1467772897
  NPD (past)
• Interface Children and Family Services

  • Community/Behavioral Health Agency
  • Oxnard, CA
  • NPI 1609177724
  NPD (past)

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765238400000",
    "number": "1679622971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5261 GOLDENRIDGE CT",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "930124129",
            "telephone_number": "805-312-4759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 S WOODRUFF AVE STE A3",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834014865",
            "telephone_number": "208-524-4818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETTLE",
        "first_name": "TRACI",
        "middle_name": "ALENE",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-09",
        "last_updated": "2025-12-09",
        "certification_date": "2025-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "ID",
            "license": "4694",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Derek Kent, MD
• Rachel Kent, BS
• Jennifer Dee Kerner, LCPC
• Dallin Kersey
• Ketamine Infusions of Idaho
• Kevin Mudrow DDS PLLC
• Kayla Nicole Key
• Mark Keyes, PHARMD
• Muad Khallad, MD
• Muhammad Arslan Khan, M.D.

• Marriage & Family Therapist in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Marriage & Family Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 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.