Provider Demographics
NPI:1114297744
Name:JUNGERT, ANNA RENE (LCSW,CADC)
Entity Type:Individual
Prefix:MS
First Name:ANNA
Middle Name:RENE
Last Name:JUNGERT
Suffix:
Gender:F
Credentials:LCSW,CADC
Other - Prefix:MRS
Other - First Name:ANNA
Other - Middle Name:RENE
Other - Last Name:MATNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, CADC
Mailing Address - Street 1:PO BOX 433
Mailing Address - Street 2:306 MAIN STREET #3
Mailing Address - City:RIGGINS
Mailing Address - State:ID
Mailing Address - Zip Code:83549-1483
Mailing Address - Country:US
Mailing Address - Phone:208-816-6958
Mailing Address - Fax:
Practice Address - Street 1:1015 S MAIN STREET
Practice Address - Street 2:
Practice Address - City:RIGGINS
Practice Address - State:ID
Practice Address - Zip Code:83549
Practice Address - Country:US
Practice Address - Phone:208-816-6958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-29069101Y00000X, 101YP2500X, 1041C0700X
ID2012-267101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical