Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Traci Alene Kettle

Individual provider Marriage & Family Therapist · NPI 1679622971

Dr. Traci Alene Kettle is a Marriage and Family Therapist in Idaho Falls, Idaho. Qualified in 2012, 14 years ago. Practices with Willow Sage Services LLC, a 4-clinician group and accepts Medicare assignment. Licensed in Idaho.

Years since qualifying
14
Licensed in
ID
In the registry since
2007
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Practice location Address checks out

211 S Woodruff Ave Ste A3
Idaho Falls, ID 83401-4865
Phone: (208) 524-4818
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Marriage & Family Therapist (primary) Taxonomy 106H00000X · Licence 4694 (ID)

Record details

NPI number1679622971
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedJanuary 9, 2007
Last updated in NPPESDecember 9, 2025
Certification dateDecember 9, 2025
Mailing address5261 Goldenridge Ct, Camarillo, CA 93012-4129

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyMARRIAGE AND FAMILY THERAPIST
Medical schoolOTHER
Graduated 2012 (14 years in practice)
Group practice Willow Sage Services Llc — 4 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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