Basic Information
Provider Information
NPI: 1811589906
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BRUBAKER
FirstName: HAHNA
MiddleName: KELLI
NamePrefix:  
NameSuffix:  
Credential: M.S., CF-SLP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 17821 LASSEN ST APT 102
Address2:  
City: NORTHRIDGE
State: CA
PostalCode: 913254702
CountryCode: US
TelephoneNumber: 6619647491
FaxNumber:  
Practice Location
Address1: 28245 AVENUE CROCKER STE 220
Address2:  
City: VALENCIA
State: CA
PostalCode: 913551201
CountryCode: US
TelephoneNumber: 6612547086
FaxNumber: 6612547108
Other Information
ProviderEnumerationDate: 02/09/2021
LastUpdateDate: 03/22/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/22/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000X15384CAY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

No ID Information.


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