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General NPI Number Information
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NPI Number | 1467383539
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Entity Type | Organization
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Legal Business Name | CONNECTED NEURODIVERGENT SUPPORTS, LLC
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Dates
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Enumeration Date | 05/27/2026
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Last Update Date | 05/27/2026
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Provider Practice Location Address
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Address Line | 9648 51ST ST NE
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City | SAINT MICHAEL
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State | MN
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Zip | 55376-7530
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Country | US
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Telephone | 310-704-1891
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Fax |
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Provider Business Mailing Address
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Address Line | 100 ATLANTIC AVE APT 900
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City | LONG BEACH
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State | CA
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Zip | 90802-5150
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | KIRSTIE RUHLAND
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Credential | CCC-SLP, BCBA
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Telephone | 310-704-1891
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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