MEDICARE: SPRING ROOTS LACTATION LLC

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	:	1669321659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPRING ROOTS LACTATION LLC

Provider Business Mailing Address
First Line	:	1718 ABERDEEN CIR
Second Line	:
City	:	CROFTON
State	:	MD
Zip	:	21114-1618
Country	:	US
Telephone Number	:	443-292-2412
Fax Number	:

Provider Business Practice Location Address
First Line	:	1718 ABERDEEN CIR
Second Line	:
City	:	CROFTON
State	:	MD
Zip	:	21114-1618
Country	:	US
Telephone Number	:	443-292-2412
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	BETHANY MCGOWAN
Credential	:	RN, IBCLC
Telephone Number	:	443-292-2412

Provider Enumeration Date	:	01/23/2026
Last Update Date	:	01/23/2026

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