Provider Demographics
NPI:1437973070
Name:CONNECT NEUROPSYCHOLOGY, PLLC
Entity type:Organization
Organization Name:CONNECT NEUROPSYCHOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:VOGEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:253-400-1379
Mailing Address - Street 1:2605 JAHN AVE NW STE D1-D2
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-8902
Mailing Address - Country:US
Mailing Address - Phone:253-400-1379
Mailing Address - Fax:253-400-1380
Practice Address - Street 1:2605 JAHN AVE NW STE D1-D2
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-8902
Practice Address - Country:US
Practice Address - Phone:253-400-1379
Practice Address - Fax:253-400-1380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty