Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Ryan M Ettner, LCSW-45249

Individual provider Clinical Social Worker · NPI 1356005367

Ryan M Ettner, LCSW-45249 is a Clinical Social Worker in Coeur D Alene, Idaho. Qualified in 2020, 6 years ago. Practices with Mind Matters LLC, a 5-clinician group and accepts Medicare assignment. Licensed in Idaho.

Years since qualifying
6
Licensed in
ID
In the registry since
2021
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Practice location Address checks out

1875 N Lakewood Dr
Coeur D Alene, ID 83814-4928
Phone: (208) 771-7284
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 45249 (ID)

Record details

NPI number1356005367
Entity typeIndividual (Type 1)
GenderMale
Credentials LCSW-45249
Sole proprietorNo
NPI enumeratedOctober 26, 2021
Last updated in NPPESDecember 19, 2025
Certification dateDecember 19, 2025

Medicare enrollment

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

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Mind Matters Llc — 5 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Coeur D Alene