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Individual

RICK PONGRATZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PH.D.

Contact information

Practice address
1138 N GALE MOUNTAIN RD, POCATELLO, ID 83204-7238
(208) 220-1974
Mailing address
1138 N GALE MOUNTAIN RD, POCATELLO, ID 83204-7238
(208) 220-1974

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY-202289
ID
103TC1900X
Counseling Psychologist
PSY-202289
ID

Other

Enumeration date
02/03/2025
Last updated
02/03/2025
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