Provider Demographics
NPI:1245952613
Name:SCOTT, SHANNON SPIKES (IBCLC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:SPIKES
Last Name:SCOTT
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3727 PALMETTO CREEK DR
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2615
Mailing Address - Country:US
Mailing Address - Phone:817-703-2145
Mailing Address - Fax:
Practice Address - Street 1:12927 PICKET HILLS LN
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-3791
Practice Address - Country:US
Practice Address - Phone:817-703-2145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X, 251K00000X
TXL-24856174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No174H00000XOther Service ProvidersHealth Educator
No251K00000XAgenciesPublic Health or Welfare