Provider Demographics
NPI:1992117576
Name:GRADY, ALISON (IBCLC, RLC, DSII)
Entity type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:
Last Name:GRADY
Suffix:
Gender:
Credentials:IBCLC, RLC, DSII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8812 GUTIERREZ RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2325
Mailing Address - Country:US
Mailing Address - Phone:505-414-7323
Mailing Address - Fax:
Practice Address - Street 1:8812 GUTIERREZ RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2325
Practice Address - Country:US
Practice Address - Phone:505-414-7392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-29
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM55979174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM# L-17110OtherIBCLE