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General NPI Number Information
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NPI Number | 1104200823
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Entity Type | Organization
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Legal Business Name | SPROUT BIRTH CENTER & NATURAL HEALTH, PLLC
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Dates
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Enumeration Date | 07/13/2015
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Last Update Date | 11/07/2015
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Provider Practice Location Address
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Address Line | 22725 44TH AVE W STE 101
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City | MOUNTLAKE TERRACE
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State | WA
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Zip | 98043-4500
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Country | US
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Telephone | 425-678-9070
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Fax | 425-420-2941
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Provider Business Mailing Address
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Address Line | 22725 44TH AVE W STE 101
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City | MOUNTLAKE TERRACE
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State | WA
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Zip | 98043-4500
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Country | US
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Telephone | 425-678-9070
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DEBORAH GLEISNER
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Credential | ND, LM, CPM
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Telephone | 206-300-8069
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | MW 60123752
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | NT 60528476
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License Number State | WA
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