Healthcare Provider Details

I. General information

NPI: 1750286977
Provider Name (Legal Business Name): REBECCA NEAL LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA NEAL CLARK LMSW

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

396 YELLOWSTONE AVE
POCATELLO ID
83201-4572
US

IV. Provider business mailing address

570 WOODBRIDGE ST
REXBURG ID
83440-5387
US

V. Phone/Fax

Practice location:
  • Phone: 208-991-4296
  • Fax:
Mailing address:
  • Phone: 208-206-8320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number4581605
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: