Provider Demographics
NPI:1306602438
Name:MONTAGUE-REYES, NANCY MARLENE
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:MARLENE
Last Name:MONTAGUE-REYES
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 1:1384 W STATE RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-4130
Mailing Address - Country:US
Mailing Address - Phone:385-202-4089
Mailing Address - Fax:
Practice Address - Street 1:10496 N OWL CIR
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:UT
Practice Address - Zip Code:84003-4708
Practice Address - Country:US
Practice Address - Phone:865-310-6698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12968267-3502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker