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General NPI Number Information
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NPI Number | 1891845954
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Entity Type | Individual
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Provider Name | MARY M. MCCRACKEN S.T.
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Gender | Female
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 04/15/2021
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Provider Practice Location Address
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Address Line | 10516 SILVERDALE WAY NW STE 110D
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City | SILVERDALE
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State | WA
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Zip | 98383-8745
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Country | US
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Telephone | 360-307-7556
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Fax | 360-698-7488
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Provider Business Mailing Address
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Address Line | 2321 NW SCHOLD PL
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City | SILVERDALE
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State | WA
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Zip | 98383-9504
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Country | US
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Telephone | 360-337-7422
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Fax | 360-698-7488
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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 | LL00003449
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License Number State | WA
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