Healthcare Provider Details

I. General information

NPI: 1669001459
Provider Name (Legal Business Name): JESSICA LOU BREADY CPM, IBCLC, CD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 CHESTERFIELD RD
NORTHBOROUGH MA
01532-2257
US

IV. Provider business mailing address

75 CHESTERFIELD RD
NORTHBOROUGH MA
01532-2257
US

V. Phone/Fax

Practice location:
  • Phone: 508-981-9298
  • Fax: 508-556-1403
Mailing address:
  • Phone: 508-981-9298
  • Fax: 508-556-1403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number19080012
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: