Provider Demographics
NPI:1639843394
Name:CRANDALL, ALISSA (CCD, CLE, LC)
Entity Type:Individual
Prefix:MRS
First Name:ALISSA
Middle Name:
Last Name:CRANDALL
Suffix:
Gender:F
Credentials:CCD, CLE, LC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1685 MCDONALD DR
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:SD
Mailing Address - Zip Code:57350-3428
Mailing Address - Country:US
Mailing Address - Phone:605-461-8239
Mailing Address - Fax:
Practice Address - Street 1:1685 MCDONALD DR
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:SD
Practice Address - Zip Code:57350-3428
Practice Address - Country:US
Practice Address - Phone:605-461-8239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN