Provider Demographics
NPI:1790928414
Name:MONTGOMERY, KATHRYN MARY (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MARY
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14825 N FAYETTE DR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-2257
Mailing Address - Country:US
Mailing Address - Phone:480-664-5200
Mailing Address - Fax:
Practice Address - Street 1:14825 N FAYETTE DR
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268
Practice Address - Country:US
Practice Address - Phone:480-664-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-10
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4257235Z00000X
AZSLPA01002355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1790928414OtherNPI