Provider Demographics
NPI:1881750248
Name:MONTOYA, GEORGIA V (MA,CCC-SLP)
Entity type:Individual
Prefix:
First Name:GEORGIA
Middle Name:V
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 44113
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87174-4113
Mailing Address - Country:US
Mailing Address - Phone:505-604-2838
Mailing Address - Fax:505-296-3518
Practice Address - Street 1:4500 COMANCHE RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-1176
Practice Address - Country:US
Practice Address - Phone:505-604-2838
Practice Address - Fax:505-296-3518
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM573235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist