Provider Demographics
NPI:1902263114
Name:THE COGNITIVE COACH LLC
Entity Type:Organization
Organization Name:THE COGNITIVE COACH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-SLP
Authorized Official - Prefix:
Authorized Official - First Name:DOREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIDGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CCC,SLP
Authorized Official - Phone:732-977-7381
Mailing Address - Street 1:2362 APPLE RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-1124
Mailing Address - Country:US
Mailing Address - Phone:732-977-7381
Mailing Address - Fax:732-292-2789
Practice Address - Street 1:2362 APPLE RIDGE CIR
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-1124
Practice Address - Country:US
Practice Address - Phone:732-977-7381
Practice Address - Fax:732-292-2789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00194500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty