Healthcare Provider Details

I. General information

NPI: 1811046394
Provider Name (Legal Business Name): JARED M NEAL LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 WOODBRIDGE ST
REXBURG ID
83440-5387
US

IV. Provider business mailing address

570 WOODBRIDGE ST
REXBURG ID
83440-5387
US

V. Phone/Fax

Practice location:
  • Phone: 208-206-9270
  • Fax:
Mailing address:
  • Phone: 208-206-9270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5334436-3501
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-26747
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: