Healthcare Provider Details

I. General information

NPI: 1437973070
Provider Name (Legal Business Name): CONNECT NEUROPSYCHOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 JAHN AVE NW STE D1-D2
GIG HARBOR WA
98335-8902
US

IV. Provider business mailing address

2605 JAHN AVE NW STE D1-D2
GIG HARBOR WA
98335-8902
US

V. Phone/Fax

Practice location:
  • Phone: 253-400-1379
  • Fax: 253-400-1380
Mailing address:
  • Phone: 253-400-1379
  • Fax: 253-400-1380

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: SALLY VOGEL
Title or Position: PRESIDENT
Credential: PHD
Phone: 253-400-1379