Provider Demographics
NPI:1437367968
Name:MONTGOMERY SPEECH CLINIC, INC.
Entity Type:Organization
Organization Name:MONTGOMERY SPEECH CLINIC, INC.
Other - Org Name:WESTERN HILLS SPEECH CLINIC, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SPEECH & LANGUAGE PATHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:K
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:513-469-0971
Mailing Address - Street 1:10768 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-3213
Mailing Address - Country:US
Mailing Address - Phone:513-469-0971
Mailing Address - Fax:513-469-1254
Practice Address - Street 1:10768 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-3213
Practice Address - Country:US
Practice Address - Phone:513-469-0971
Practice Address - Fax:513-469-1254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP2139235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH36-6572Medicare ID - Type Unspecified