Provider Demographics
NPI:1104200823
Name:SPROUT BIRTH CENTER & NATURAL HEALTH, PLLC
Entity Type:Organization
Organization Name:SPROUT BIRTH CENTER & NATURAL HEALTH, PLLC
Other - Org Name:SPROUT BIRTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GLEISNER
Authorized Official - Suffix:
Authorized Official - Credentials:ND, LM, CPM
Authorized Official - Phone:206-300-8069
Mailing Address - Street 1:22725 44TH AVE W STE 101
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-4500
Mailing Address - Country:US
Mailing Address - Phone:425-678-9070
Mailing Address - Fax:
Practice Address - Street 1:22725 44TH AVE W STE 101
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-4500
Practice Address - Country:US
Practice Address - Phone:425-678-9070
Practice Address - Fax:425-420-2941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-13
Last Update Date:2015-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT 60528476175F00000X
WAMW 60123752176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty