Provider Demographics
NPI:1497049712
Name:MONTGOMERY, CASSANDRA ERIN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:ERIN
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:CASSIE
Other - Middle Name:ERIN
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:PO BOX 828
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-8144
Mailing Address - Country:US
Mailing Address - Phone:972-562-0190
Mailing Address - Fax:
Practice Address - Street 1:1416 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-1806
Practice Address - Country:US
Practice Address - Phone:972-359-1110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105747235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist