Provider Demographics
NPI:1417610916
Name:MCCRACKEN, BETHANY JANE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:JANE
Last Name:MCCRACKEN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 WALTER ST SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-4247
Mailing Address - Country:US
Mailing Address - Phone:505-901-2572
Mailing Address - Fax:
Practice Address - Street 1:805 WALTER ST SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-4247
Practice Address - Country:US
Practice Address - Phone:505-901-2572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist