MEDICARE: SAVANN SPENCE 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-317209	AZ

General Provider Information

NPI Number	:	1558214882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAVANN SPENCE IBCLC

Provider Business Mailing Address
First Line	:	107 MISSISSIPPI LOOP
Second Line	:
City	:	JACKSONVILLE
State	:	AR
Zip	:	72076-1129
Country	:	US
Telephone Number	:	701-330-4321
Fax Number	:

Provider Business Practice Location Address
First Line	:	107 MISSISSIPPI LOOP
Second Line	:
City	:	JACKSONVILLE
State	:	AR
Zip	:	72076-1129
Country	:	US
Telephone Number	:	701-330-4321
Fax Number	:

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

Provider Enumeration Date	:	02/17/2026
Last Update Date	:	02/17/2026

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Directions to “ SAVANN SPENCE IBCLC” Practice Location

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