Provider Demographics
NPI:1770645715
Name:MONTGOMERY-EARL, PAMELA ELLEN (AUD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:ELLEN
Last Name:MONTGOMERY-EARL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:PAMELA
Other - Middle Name:ELLEN
Other - Last Name:MONTGOMERY-EARL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AUD
Mailing Address - Street 1:161 W 200 N STE 101
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-2728
Mailing Address - Country:US
Mailing Address - Phone:435-688-2456
Mailing Address - Fax:
Practice Address - Street 1:161 W 200 N STE 101
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-2728
Practice Address - Country:US
Practice Address - Phone:435-688-2456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1127231H00000X
AZDA9775237600000X
UT69490784101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU2518ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
U2518ZMedicare PIN