Healthcare Provider Details

I. General information

NPI: 1639843394
Provider Name (Legal Business Name): ALISSA CRANDALL CPM, CCD, CLC, CLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2021
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 21ST ST SW STE 2
HURON SD
57350-4399
US

IV. Provider business mailing address

800 21ST ST SW STE 2
HURON SD
57350-4399
US

V. Phone/Fax

Practice location:
  • Phone: 605-461-8239
  • Fax:
Mailing address:
  • Phone: 605-461-8239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number002201
License Number StateSD
# 3
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: