Provider Demographics
NPI:1144459504
Name:MONTAGUE, JUDITH IRENE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:IRENE
Last Name:MONTAGUE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 BRICKYARD RD STE 109
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-2593
Mailing Address - Country:US
Mailing Address - Phone:801-746-4334
Mailing Address - Fax:801-746-4337
Practice Address - Street 1:1111 BRICKYARD RD STE 109
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-2593
Practice Address - Country:US
Practice Address - Phone:801-746-4334
Practice Address - Fax:801-746-4337
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT67569253501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health