Individual provider · Type 1 NPI

Tamara K. Pettingill, LCSW

Clinical Social Worker · Idaho Falls, ID

NPI number 1629081864 Active

Practice location

1302 E 17th St
Idaho Falls, ID 83404-6270

Call (208) 542-9199 Map

Fax (208) 542-6272

Specialties and licenses

TaxonomyCodeLicense
Clinical Social Worker 1041C0700XNone listed
Clinical Social Worker Primary 1041C0700XLCSW-24477 (ID)

Clinical Social Worker: A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpers…

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About NPI 1629081864

Tamara K. Pettingill, LCSW's National Provider Identifier is 1629081864, issued on Aug 15, 2006. The primary taxonomy on file is Clinical Social Worker (1041C0700X), and the practice location is in Idaho Falls, ID. The record was last updated on Jul 24, 2026.