Provider Demographics
NPI:1093003857
Name:MONTOYA, TRISTA LYNN
Entity Type:Individual
Prefix:
First Name:TRISTA
Middle Name:LYNN
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TRISTA
Other - Middle Name:LYNN
Other - Last Name:GENG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4969 MOUNT UNION CT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-7930
Mailing Address - Country:US
Mailing Address - Phone:575-312-4859
Mailing Address - Fax:
Practice Address - Street 1:4969 MOUNT UNION CT
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-7930
Practice Address - Country:US
Practice Address - Phone:719-354-4401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-4951235Z00000X
CO0001463235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist