Individual
MS. TAMARA K. PETTINGILL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1302 E 17TH ST, IDAHO FALLS, ID 83404-6270
(208) 542-9199
(208) 542-6272
Mailing address
1302 E 17TH ST, IDAHO FALLS, ID 83404-6270
(208) 542-9199
(208) 542-6272
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
LCSW-24477
ID
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806803500
—
ID
05
—
806836700
—
ID
05
—
806864000
—
ID
Enumeration date
08/15/2006
Last updated
04/21/2025
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