Healthcare Provider Details

I. General information

NPI: 1124661152
Provider Name (Legal Business Name): CONNECTED COGNITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2019
Last Update Date: 10/27/2021
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 NW WALL ST STE 303
BEND OR
97703-1970
US

IV. Provider business mailing address

1345 NW WALL ST STE 303
BEND OR
97703-1970
US

V. Phone/Fax

Practice location:
  • Phone: 781-288-5141
  • Fax: 541-797-6471
Mailing address:
  • Phone: 781-288-5141
  • Fax: 541-797-6471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: ROBYN ASHLEY MIGLIORINI
Title or Position: OWNER
Credential: PHD
Phone: 781-288-5141