Provider Demographics
NPI:1467969709
Name:MCCRACKIN, AMY K
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:K
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 1:9153 W 133RD ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-4333
Mailing Address - Country:US
Mailing Address - Phone:913-257-5185
Mailing Address - Fax:833-340-7117
Practice Address - Street 1:9153 W 133RD ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-4333
Practice Address - Country:US
Practice Address - Phone:913-257-5185
Practice Address - Fax:833-340-7117
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
MO2021033739103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician