Provider Demographics
NPI:1811589906
Name:BRUBAKER, HAHNA KELLI (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:HAHNA
Middle Name:KELLI
Last Name:BRUBAKER
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17821 LASSEN ST APT 102
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4702
Mailing Address - Country:US
Mailing Address - Phone:661-964-7491
Mailing Address - Fax:
Practice Address - Street 1:28245 AVENUE CROCKER STE 220
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-1201
Practice Address - Country:US
Practice Address - Phone:661-254-7086
Practice Address - Fax:661-254-7108
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15384235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist