Organization
COGNITIVE CARE MEDICAL GROUP LLC
Active
Other names
Cognitive Care Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC G WIGHT (MANAGER)
(503) 912-4788
Entity
Organization
Contact information
Practice address
12901 SE 97TH AVE STE 105, CLACKAMAS, OR 97015-7902
(503) 912-4788
(503) 912-4787
Mailing address
12901 SE 97TH AVE STE 105, CLACKAMAS, OR 97015-7902
(503) 912-4788
(503) 912-4787
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
—
—
2084F0202X
Forensic Psychiatry Physician
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500723541
—
OR
Enumeration date
03/03/2017
Last updated
03/04/2026
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