Provider Demographics
NPI:1376509950
Name:MCCRACKEN, HEATHER (CSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MCCRACKEN
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-0010
Mailing Address - Country:US
Mailing Address - Phone:517-676-9788
Mailing Address - Fax:
Practice Address - Street 1:13323 S WRIGHT RD
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:MI
Practice Address - Zip Code:48822-9712
Practice Address - Country:US
Practice Address - Phone:517-743-1198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-24
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801064350104100000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty