Provider Demographics
NPI:1841265881
Name:MONTGOMERY, SHERRY R (LSCSW)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:R
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5326 NALL AVE
Mailing Address - Street 2:
Mailing Address - City:ROELAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66202-1963
Mailing Address - Country:US
Mailing Address - Phone:913-967-9013
Mailing Address - Fax:
Practice Address - Street 1:5326 NALL AVE
Practice Address - Street 2:
Practice Address - City:ROELAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66202-1963
Practice Address - Country:US
Practice Address - Phone:913-967-9013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0034021041C0700X
KS11171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical