Healthcare Provider Details

I. General information

NPI: 1891629630
Provider Name (Legal Business Name): SHANNON FRANCIS CLEGG RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 S 980 E
AMERICAN FORK UT
84003-2391
US

IV. Provider business mailing address

194 S 980 E
AMERICAN FORK UT
84003-2391
US

V. Phone/Fax

Practice location:
  • Phone: 801-547-7684
  • Fax:
Mailing address:
  • Phone: 801-547-7684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-16658
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number212706-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: