Provider Demographics
NPI:1821802810
Name:RICK PONGRATZ, PHD, PLLC
Entity type:Organization
Organization Name:RICK PONGRATZ, PHD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:PONGRATZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:208-220-1974
Mailing Address - Street 1:1138 N GALE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83204-7238
Mailing Address - Country:US
Mailing Address - Phone:208-220-1974
Mailing Address - Fax:
Practice Address - Street 1:1138 N GALE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83204-7238
Practice Address - Country:US
Practice Address - Phone:208-220-1974
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty