MEDICARE: MRS. JESSICA MARIE BOWERS 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)

General Provider Information

NPI Number	:	1184376303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA MARIE BOWERS IBCLC

Provider Business Mailing Address
First Line	:	4911 140TH AVE SW
Second Line	:
City	:	ROCHESTER
State	:	WA
Zip	:	98579-9711
Country	:	US
Telephone Number	:	360-999-6790
Fax Number	:

Provider Business Practice Location Address
First Line	:	4911 140TH AVE SW
Second Line	:
City	:	ROCHESTER
State	:	WA
Zip	:	98579-9711
Country	:	US
Telephone Number	:	360-999-6790
Fax Number	:

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

Provider Enumeration Date	:	01/19/2022
Last Update Date	:	01/19/2022

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