Individual
KATIE JACOBY MCCRACKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CAPSW, SAC-IT
Contact information
Practice address
300 CROOKS ST, GREEN BAY, WI 54301-4527
(920) 436-6800
(920) 432-5966
Mailing address
PO BOX 22308, GREEN BAY, WI 54305-2308
(920) 436-6800
(920) 432-5966
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
16558
WI
101YA0400X
Addiction (Substance Use Disorder) Counselor
17661
WI
104100000X
Social Worker
Primary
130643
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1669004198
—
WI
Enumeration date
02/12/2020
Last updated
10/01/2021
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