Individual
ANDREY MACCRACKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7916 SE FOSTER RD STE 201, PORTLAND, OR 97206-4289
(503) 290-8850
Mailing address
PO BOX 16576, PORTLAND, OR 97292-0576
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
23-CRM-II-0169
OR
Other
Enumeration date
04/10/2025
Last updated
04/10/2025
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