Provider Demographics
NPI:1013432046
Name:MONTAGNA, JANINE (SLP)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:
Last Name:MONTAGNA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12004 W MORNING DOVE DR
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85373-5664
Mailing Address - Country:US
Mailing Address - Phone:623-252-7289
Mailing Address - Fax:
Practice Address - Street 1:12004 W MORNING DOVE DR
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85373-5664
Practice Address - Country:US
Practice Address - Phone:623-252-7289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA107012355S0801X
AZTSLP10701235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant