Provider Demographics
NPI:1093774846
Name:MONT, EUSEBIA VICTORIA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:EUSEBIA
Middle Name:VICTORIA
Last Name:MONT
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 LEFRAK HALL
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20742-8211
Mailing Address - Country:US
Mailing Address - Phone:301-405-4237
Mailing Address - Fax:
Practice Address - Street 1:100 LEFRAK HALL
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20742-8211
Practice Address - Country:US
Practice Address - Phone:301-405-4237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05216235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist