Provider Demographics
NPI:1508320441
Name:GANSKY, HEATHER A (IBCLC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:A
Last Name:GANSKY
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:A
Other - Last Name:GANSKY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:IBCLC
Mailing Address - Street 1:34 CRAIG ST
Mailing Address - Street 2:
Mailing Address - City:WATERVLIET
Mailing Address - State:NY
Mailing Address - Zip Code:12189-1815
Mailing Address - Country:US
Mailing Address - Phone:518-209-6465
Mailing Address - Fax:
Practice Address - Street 1:34 CRAIG ST
Practice Address - Street 2:
Practice Address - City:WATERVLIET
Practice Address - State:NY
Practice Address - Zip Code:12189-1815
Practice Address - Country:US
Practice Address - Phone:518-209-6465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYL-151130174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN