Provider Demographics
NPI:1558737783
Name:MONTZKA-BEAL, JENNIFER LEIGH (MS)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LEIGH
Last Name:MONTZKA-BEAL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LEIGH
Other - Last Name:MONTZKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:320 11TH AVE S
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-5073
Mailing Address - Country:US
Mailing Address - Phone:208-466-1077
Mailing Address - Fax:120-467-2201
Practice Address - Street 1:320 11TH AVE S
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-5073
Practice Address - Country:US
Practice Address - Phone:208-466-1077
Practice Address - Fax:120-467-2201
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-3027235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist