Provider Demographics
NPI:1154040970
Name:BERRY, RANDI (BS, IBCLC)
Entity type:Individual
Prefix:
First Name:RANDI
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:BS, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19100 W LAKE HOUSTON PKWY STE 104
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-5139
Mailing Address - Country:US
Mailing Address - Phone:281-626-8241
Mailing Address - Fax:
Practice Address - Street 1:19100 W LAKE HOUSTON PKWY STE 104
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-5139
Practice Address - Country:US
Practice Address - Phone:281-626-8241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty