Provider Demographics
NPI:1003283367
Name:MCCRACKIN, AMBER
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:MCCRACKIN
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 1:4749 HIGHWAY 9
Mailing Address - Street 2:
Mailing Address - City:LEOLA
Mailing Address - State:AR
Mailing Address - Zip Code:72084-8987
Mailing Address - Country:US
Mailing Address - Phone:501-467-6002
Mailing Address - Fax:
Practice Address - Street 1:14334 HIGHWAY 67
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:AR
Practice Address - Zip Code:72104-7328
Practice Address - Country:US
Practice Address - Phone:501-332-3694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist