Provider Demographics
NPI:1376777409
Name:MONTGOMERY, TRICIA M (PHD, CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:TRICIA
Middle Name:M
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:PHD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3022 BROOKMONT DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-2407
Mailing Address - Country:US
Mailing Address - Phone:850-445-8687
Mailing Address - Fax:
Practice Address - Street 1:3022 BROOKMONT DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-2407
Practice Address - Country:US
Practice Address - Phone:850-445-8687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-04
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5476235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist