Provider Demographics
NPI:1518132893
Name:MACCRACKEN, ELLEN LOUISE (MS)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:LOUISE
Last Name:MACCRACKEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 LARCH ROAD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423
Mailing Address - Country:US
Mailing Address - Phone:815-464-9971
Mailing Address - Fax:815-464-9971
Practice Address - Street 1:UNIVERSITY OF CHICAGO MEDICAL CENTER
Practice Address - Street 2:5758 S. MARYLAND AVENUE, MC 9020
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637
Practice Address - Country:US
Practice Address - Phone:773-702-1923
Practice Address - Fax:773-795-8346
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist