Healthcare Provider Details

I. General information

NPI: 1912455742
Provider Name (Legal Business Name): JENNIFER NEGRETTE ED.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2016
Last Update Date: 09/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 6TH ST
RAPID CITY SD
57701-5034
US

IV. Provider business mailing address

300 6TH ST
RAPID CITY SD
57701-5034
US

V. Phone/Fax

Practice location:
  • Phone: 605-394-4036
  • Fax: 604-394-5119
Mailing address:
  • Phone: 605-394-4036
  • Fax: 604-394-5119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number68715-1
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: