Provider Demographics
NPI:1417832353
Name:EGGERTH, CAROLINE WHITNEY (COUI)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:WHITNEY
Last Name:EGGERTH
Suffix:
Gender:F
Credentials:COUI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 PARK MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3216
Mailing Address - Country:US
Mailing Address - Phone:208-421-5975
Mailing Address - Fax:
Practice Address - Street 1:2647 KIMBERLY RD STE 2
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-7976
Practice Address - Country:US
Practice Address - Phone:208-734-1281
Practice Address - Fax:208-734-1282
Is Sole Proprietor?:No
Enumeration Date:2025-08-08
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID3971961101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional