Provider Demographics
NPI:1326345307
Name:MONTGOMERY, AMANDA CARROLL (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:CARROLL
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 S BISHOP AVE
Mailing Address - Street 2:
Mailing Address - City:SECANE
Mailing Address - State:PA
Mailing Address - Zip Code:19018-2019
Mailing Address - Country:US
Mailing Address - Phone:484-574-9968
Mailing Address - Fax:
Practice Address - Street 1:205 S BISHOP AVE
Practice Address - Street 2:
Practice Address - City:SECANE
Practice Address - State:PA
Practice Address - Zip Code:19018-2019
Practice Address - Country:US
Practice Address - Phone:484-574-9968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL010272235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist