Provider Demographics
NPI:1164520409
Name:MONTGOMERY, ROSE INES (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:INES
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4708 HANNETT AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-5016
Mailing Address - Country:US
Mailing Address - Phone:505-268-5098
Mailing Address - Fax:505-262-1903
Practice Address - Street 1:1420 CARLISLE BLVD NE # ST.201-E
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-5660
Practice Address - Country:US
Practice Address - Phone:505-255-6141
Practice Address - Fax:505-262-1903
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM140235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist