MEDICARE: JESSICA SEMAR IBCLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174N00000X	Lactation Consultant (Non-RN)	L-164351

General Provider Information

NPI Number	:	1003447632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA SEMAR IBCLC

Provider Business Mailing Address
First Line	:	8701 PUCKETT CT
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78749-3626
Country	:	US
Telephone Number	:	512-964-3175
Fax Number	:

Provider Business Practice Location Address
First Line	:	2222 WESTERN TRAILS BLVD STE 101
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-1601
Country	:	US
Telephone Number	:	817-203-4881
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2020
Last Update Date	:	05/04/2024

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