Provider Demographics
NPI:1134963143
Name:MONTGOMERY, MONICA S
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:S
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 SCHROCK RD STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-1165
Mailing Address - Country:US
Mailing Address - Phone:614-999-1118
Mailing Address - Fax:614-337-1186
Practice Address - Street 1:2225 N CASSADY AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-1512
Practice Address - Country:US
Practice Address - Phone:614-999-1118
Practice Address - Fax:614-337-1186
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator