Healthcare Provider Details

I. General information

NPI: 1104200823
Provider Name (Legal Business Name): SPROUT BIRTH CENTER & NATURAL HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2015
Last Update Date: 11/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22725 44TH AVE W STE 101
MOUNTLAKE TERRACE WA
98043-4500
US

IV. Provider business mailing address

22725 44TH AVE W STE 101
MOUNTLAKE TERRACE WA
98043-4500
US

V. Phone/Fax

Practice location:
  • Phone: 425-678-9070
  • Fax: 425-420-2941
Mailing address:
  • Phone: 425-678-9070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT 60528476
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW 60123752
License Number StateWA

VIII. Authorized Official

Name: DEBORAH GLEISNER
Title or Position: OWNER
Credential: ND, LM, CPM
Phone: 206-300-8069