Provider Demographics
NPI:1760553598
Name:MONTGOMERY, REBECCA (MSCCC,SLP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:MSCCC,SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 OLEVA DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45440-3703
Mailing Address - Country:US
Mailing Address - Phone:937-426-0433
Mailing Address - Fax:
Practice Address - Street 1:570 OLEVA DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45440-3703
Practice Address - Country:US
Practice Address - Phone:937-426-0433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP6050235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist