Provider Demographics
NPI:1184904427
Name:MONTGOMERY, WENDY (SLP)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:
Last Name:MONTGOMERY
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 1:115 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:IA
Mailing Address - Zip Code:51652-6069
Mailing Address - Country:US
Mailing Address - Phone:712-374-2693
Mailing Address - Fax:
Practice Address - Street 1:115 MAIN ST
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:IA
Practice Address - Zip Code:51652-6069
Practice Address - Country:US
Practice Address - Phone:712-374-2693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-18
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1523235Z00000X
IA002261235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA002261OtherIOWA STATE LICENSE
NE1523OtherNEBRASKA STATE LICENSE