Healthcare Provider Details

I. General information

NPI: 1588417778
Provider Name (Legal Business Name): THE NEUTRAL AGENCY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14777 W HIGHWAY 53
RATHDRUM ID
83858-8596
US

IV. Provider business mailing address

PO BOX 1185
RATHDRUM ID
83858-1185
US

V. Phone/Fax

Practice location:
  • Phone: 208-755-1343
  • Fax:
Mailing address:
  • Phone: 208-755-1343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE J THOMPSON
Title or Position: MANAGING MEMBER
Credential: LMSW
Phone: 208-755-1343