Individual
MS. TISHA GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPM, ICBD, ICCE, CLC
Contact information
Practice address
40 WASHINGTON AVENUE, ROUND LAKE, NY 12151
(518) 366-2159
Mailing address
40 WASHINGTON AVENUE, P.O. BOX 41, ROUND LAKE, NY 12151
(518) 366-2159
Taxonomy
Speciality
Code
Description
License number
State
174N00000X
Lactation Consultant (Non-RN)
—
NY
176B00000X
Midwife
Primary
107.0085724
VT
374J00000X
Doula
—
NY
Other
Enumeration date
04/25/2023
Last updated
04/25/2023
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