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General NPI Number Information
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NPI Number | 1013031558
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Entity Type | Individual
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Provider Name | MARY KATHRYN MCCRACKEN M.A., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 15600 SAN PEDRO AVE SUITE 307
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City | SAN ANTONIO
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State | TX
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Zip | 78232-3740
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Country | US
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Telephone | 800-437-7560
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Fax |
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Provider Business Mailing Address
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Address Line | 9411 MARSH CREEK DR
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City | SAN ANTONIO
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State | TX
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Zip | 78250-3529
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Country | US
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Telephone | 210-842-0321
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 100094
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License Number State | TX
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