Gracey Larue
Individual provider Active NPI Behavior Technician · Farr West, UT
NPI 1114799681 · NPPES record last updated Oct 26, 2023
Key facts
- NPI
- 1114799681
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Technician 106S00000X
- License
- 220871321 (UT)
- Practice address
- 2811 N 2350 W
Farr West, UT 84404-5177 - Phone
- (801) 872-8757
- NPI assigned
- Oct 26, 2023
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 220871321 | UT | MD | Behavior Technician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | 220871321 | UT | Yes |
Addresses
Primary practice location
2811 N 2350 W
Farr West, UT 84404-5177
Mailing address
2811 N 2350 W
Farr West, UT 84404-5177
Phone (801) 872-8757
Other providers in Farr West, UT
- Knight Family Dentistry LLC
- Samuel Don Knight
- Spencer Knight
- Taylor Knighton
- Bruce D Larsen
- Lotus Aesthetics and Wellness
- Chelnecha Hardy Lowry
- Kapuaonalani S Makuakane
- Nathan Harrison Mangum
- Joseph Ben Markland
All providers in Farr West, UT · Behavior Technician in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 26, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.