Provider Demographics
NPI:1053539064
Name:BRUBAKKEN, DAVID M (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:BRUBAKKEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2910 E MADISON ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-4214
Mailing Address - Country:US
Mailing Address - Phone:206-323-7694
Mailing Address - Fax:206-322-7807
Practice Address - Street 1:2910 E MADISON ST
Practice Address - Street 2:SUITE 305
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-4214
Practice Address - Country:US
Practice Address - Phone:206-323-7694
Practice Address - Fax:206-322-7807
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA691103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical