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General NPI Number Information
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NPI Number | 1902263114
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Entity Type | Organization
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Legal Business Name | THE COGNITIVE COACH LLC
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Dates
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Enumeration Date | 01/19/2016
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Last Update Date | 01/19/2016
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Provider Practice Location Address
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Address Line | 2362 APPLE RIDGE CIR
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City | MANASQUAN
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State | NJ
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Zip | 08736-1124
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Country | US
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Telephone | 732-977-7381
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Fax | 732-292-2789
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Provider Business Mailing Address
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Address Line | 2362 APPLE RIDGE CIR
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City | MANASQUAN
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State | NJ
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Zip | 08736-1124
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Country | US
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Telephone | 732-977-7381
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Fax | 732-292-2789
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Authorized Official
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Title or Position | OWNER-SLP
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Name | DOREEN BRIDGMAN
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Credential | MS,CCC,SLP
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Telephone | 732-977-7381
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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 | 41YS00194500
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License Number State | NJ
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