Healthcare Provider Details

I. General information

NPI: 1467383539
Provider Name (Legal Business Name): CONNECTED NEURODIVERGENT SUPPORTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9648 51ST ST NE
SAINT MICHAEL MN
55376-7530
US

IV. Provider business mailing address

100 ATLANTIC AVE APT 900
LONG BEACH CA
90802-5150
US

V. Phone/Fax

Practice location:
  • Phone: 310-704-1891
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: KIRSTIE RUHLAND
Title or Position: MANAGING MEMBER
Credential: CCC-SLP, BCBA
Phone: 310-704-1891