Basic Information
| Provider Information | |||||||||
| NPI: | 1316323231 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCRACKEN | ||||||||
| FirstName: | ALEXANDRA | ||||||||
| MiddleName: | REBECCA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 1453 | ||||||||
| Address2: | |||||||||
| City: | MOUNT CARMEL | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37645 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 301 LOUIS ST. #101 | ||||||||
| Address2: | MOUNTAIN REGION SPEECH & HEARING CENTER | ||||||||
| City: | KINGSPORT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232464600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2015 | ||||||||
| LastUpdateDate: | 08/03/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 3214 | TN | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.