Provider Demographics
NPI:1942472196
Name:MONTGOMERY, JODI RENAE
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:RENAE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:RENAE
Other - Last Name:MAKELA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5929 FASHION POINT DR STE 130
Mailing Address - Street 2:
Mailing Address - City:SOUTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-4683
Mailing Address - Country:US
Mailing Address - Phone:385-333-4703
Mailing Address - Fax:
Practice Address - Street 1:5929 FASHION POINT DR STE 130
Practice Address - Street 2:
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4683
Practice Address - Country:US
Practice Address - Phone:385-333-4703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health