Provider Demographics
NPI:1326831967
Name:NEGRETTE, GRACE MACKENZIE
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:MACKENZIE
Last Name:NEGRETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 S 8TH ST APT J
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-3976
Mailing Address - Country:US
Mailing Address - Phone:406-661-1029
Mailing Address - Fax:
Practice Address - Street 1:1575 N 4TH ST STE 105
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-2091
Practice Address - Country:US
Practice Address - Phone:307-212-3284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician