Provider Demographics
NPI:1265040059
Name:MONTGOMERY, JEANNETTE M
Entity Type:Individual
Prefix:MS
First Name:JEANNETTE
Middle Name:M
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 N I 10 SERVICE RD W STE 117
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-6831
Mailing Address - Country:US
Mailing Address - Phone:504-228-5641
Mailing Address - Fax:
Practice Address - Street 1:3925 N I 10 SERVICE RD W STE 117
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-6831
Practice Address - Country:US
Practice Address - Phone:504-482-2735
Practice Address - Fax:504-482-2737
Is Sole Proprietor?:No
Enumeration Date:2020-07-17
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator