Healthcare Provider Details

I. General information

NPI: 1497514905
Provider Name (Legal Business Name): ASHLEY BRUBAKER LMSW, PMH-C, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 E BASELINE RD STE 200
GILBERT AZ
85234-2405
US

IV. Provider business mailing address

2451 E BASELINE RD STE 200
GILBERT AZ
85234-2405
US

V. Phone/Fax

Practice location:
  • Phone: 480-507-2199
  • Fax:
Mailing address:
  • Phone: 480-507-2199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW-17966
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-314945
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: