Provider Demographics
NPI:1821634726
Name:MONTOYA, MARY FRANCES (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:FRANCES
Last Name:MONTOYA
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 1:482 W 800 S
Mailing Address - Street 2:
Mailing Address - City:TREMONTON
Mailing Address - State:UT
Mailing Address - Zip Code:84337-1970
Mailing Address - Country:US
Mailing Address - Phone:435-237-7662
Mailing Address - Fax:
Practice Address - Street 1:4681 W 9050 N
Practice Address - Street 2:
Practice Address - City:ELWOOD
Practice Address - State:UT
Practice Address - Zip Code:84337-8757
Practice Address - Country:US
Practice Address - Phone:435-237-7662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT105529174102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist