Provider Demographics
NPI:1215265491
Name:ROSE MONTGOMERY, M.S., CCC, P.C.
Entity type:Organization
Organization Name:ROSE MONTGOMERY, M.S., CCC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH/LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:INES
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:505-268-5098
Mailing Address - Street 1:4708 HANNETT AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-5016
Mailing Address - Country:US
Mailing Address - Phone:505-268-5098
Mailing Address - Fax:505-262-1903
Practice Address - Street 1:1420 CARLISLE BLVD NE
Practice Address - Street 2:ST. 201-E
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-5660
Practice Address - Country:US
Practice Address - Phone:505-255-6141
Practice Address - Fax:505-262-1903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-25
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM140261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1164520409OtherINDIVIDUAL NPI NUMBER