Provider Demographics
NPI:1205089760
Name:MONTIJO, MARY JO (SLP-CCC, MS, TSHH)
Entity type:Individual
Prefix:MRS
First Name:MARY JO
Middle Name:
Last Name:MONTIJO
Suffix:
Gender:F
Credentials:SLP-CCC, MS, TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:7214 FORT HAMILTON PKWY
Mailing Address - Street 2:3B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-1906
Mailing Address - Country:US
Mailing Address - Phone:347-394-4510
Mailing Address - Fax:347-394-2510
Practice Address - Street 1:7214 FORT HAMILTON PKWY
Practice Address - Street 2:3B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-1906
Practice Address - Country:US
Practice Address - Phone:347-394-4510
Practice Address - Fax:347-394-4510
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016636-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist