Provider Demographics
NPI:1366894628
Name:AMBER MCCRACKIN LLC
Entity type:Organization
Organization Name:AMBER MCCRACKIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCRACKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:501-467-6002
Mailing Address - Street 1:PO BOX 96
Mailing Address - Street 2:
Mailing Address - City:PRATTSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72129-0096
Mailing Address - Country:US
Mailing Address - Phone:501-467-6002
Mailing Address - Fax:
Practice Address - Street 1:1807 W MOLINE ST
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:AR
Practice Address - Zip Code:72104-2645
Practice Address - Country:US
Practice Address - Phone:501-467-6002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4045235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty