Provider Demographics
NPI:1710072459
Name:CRAKER, RONALD A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:A
Last Name:CRAKER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53078 COUNTY KERRY DR
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-9400
Mailing Address - Country:US
Mailing Address - Phone:574-272-4099
Mailing Address - Fax:866-751-7170
Practice Address - Street 1:53078 COUNTY KERRY DR
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-9400
Practice Address - Country:US
Practice Address - Phone:574-272-4099
Practice Address - Fax:866-751-7170
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040989A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN20040989AOtherPSYCHOLOGIST LICENSE