Provider Demographics
NPI:1811626369
Name:MONTGOMERY, BRIDGET (LCPC)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2441 N FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-0582
Mailing Address - Country:US
Mailing Address - Phone:312-504-2179
Mailing Address - Fax:
Practice Address - Street 1:2441 N FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-0582
Practice Address - Country:US
Practice Address - Phone:312-504-2179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional