Provider Demographics
NPI:1811465099
Name:CRANK, WILLACLARE FRANKLIN
Entity type:Individual
Prefix:
First Name:WILLACLARE
Middle Name:FRANKLIN
Last Name:CRANK
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 1:16205 NW BETHANY CT STE 116
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-4687
Mailing Address - Country:US
Mailing Address - Phone:503-860-6525
Mailing Address - Fax:
Practice Address - Street 1:16205 NW BETHANY CT STE 116
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-4687
Practice Address - Country:US
Practice Address - Phone:503-860-6525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
1-22-60835103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician