Provider Demographics
NPI:1689974560
Name:MCCRACKEN, PATRICE DUDLEY (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:PATRICE
Middle Name:DUDLEY
Last Name:MCCRACKEN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MARCEL CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-3652
Mailing Address - Country:US
Mailing Address - Phone:513-720-0350
Mailing Address - Fax:
Practice Address - Street 1:10 MARCEL CT
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-3652
Practice Address - Country:US
Practice Address - Phone:513-720-0350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP3492235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist