Healthcare Provider Details

I. General information

NPI: 1003754508
Provider Name (Legal Business Name): MADELEINE ANNE BOTT IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1871 QUIVIRA RD
WASHINGTON KS
66968-8655
US

IV. Provider business mailing address

1871 QUIVIRA RD
WASHINGTON KS
66968-8655
US

V. Phone/Fax

Practice location:
  • Phone: 979-255-1699
  • Fax:
Mailing address:
  • Phone: 979-255-1699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-320061
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: