MEDICARE: JENNIFER LEAH BASSETT 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-317233	TX

General Provider Information

NPI Number	:	1790623395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LEAH BASSETT IBCLC

Provider Business Mailing Address
First Line	:	3850 FM 518 RD E APT 3401
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-0797
Country	:	US
Telephone Number	:	208-704-4323
Fax Number	:

Provider Business Practice Location Address
First Line	:	3850 FM 518 RD E APT 3401
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-0797
Country	:	US
Telephone Number	:	208-704-4323
Fax Number	:

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

Provider Enumeration Date	:	03/24/2026
Last Update Date	:	03/24/2026

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