Provider Demographics
NPI:1366215600
Name:RYCRAFT, CALLIE RENAE
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:RENAE
Last Name:RYCRAFT
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 1:970 W BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-7072
Mailing Address - Country:US
Mailing Address - Phone:417-850-6699
Mailing Address - Fax:
Practice Address - Street 1:1531 E BRADFORD PKWY STE 210-4
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-6539
Practice Address - Country:US
Practice Address - Phone:417-881-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20220362162355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant