Provider Demographics
NPI:1861790933
Name:JEAN M. MONTY PHD PSYCHOLOGICAL SERVICES LLC
Entity type:Organization
Organization Name:JEAN M. MONTY PHD PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MONTY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:262-377-2006
Mailing Address - Street 1:14135 N CEDARBURG RD
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53097-1416
Mailing Address - Country:US
Mailing Address - Phone:262-377-2006
Mailing Address - Fax:262-377-5552
Practice Address - Street 1:14135 N CEDARBURG RD
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53097-1416
Practice Address - Country:US
Practice Address - Phone:262-377-2006
Practice Address - Fax:262-377-5552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-14
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1880103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1417001579Medicaid