Provider Demographics
NPI:1639124407
Name:MCCRACKEN, RACHEL ANNE (MB CHB)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ANNE
Last Name:MCCRACKEN
Suffix:
Gender:F
Credentials:MB CHB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5046
Mailing Address - Street 2:116C
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5046
Mailing Address - Country:US
Mailing Address - Phone:605-333-6865
Mailing Address - Fax:605-373-4119
Practice Address - Street 1:2501 W 22ND ST
Practice Address - Street 2:116C
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1305
Practice Address - Country:US
Practice Address - Phone:605-333-6865
Practice Address - Fax:605-373-4119
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD46982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry