Provider Demographics
NPI:1477963643
Name:MONTGOMERY, JEAN ANNE (MA,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:ANNE
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 1:5900 METRO DR
Mailing Address - Street 2:THE HEARING AND SPEECH AGENCY
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-3207
Mailing Address - Country:US
Mailing Address - Phone:410-318-6780
Mailing Address - Fax:410-318-6738
Practice Address - Street 1:5900 METRO DR
Practice Address - Street 2:THE HEARING AND SPEECH AGENCY
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-3207
Practice Address - Country:US
Practice Address - Phone:410-318-6780
Practice Address - Fax:410-318-6738
Is Sole Proprietor?:No
Enumeration Date:2014-04-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07289235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist