Provider Demographics
NPI:1386979201
Name:MONTGOMERY, NANCY SUE (SLP)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:SUE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 BROADWAY ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-2659
Mailing Address - Country:US
Mailing Address - Phone:816-231-7166
Mailing Address - Fax:816-231-7899
Practice Address - Street 1:1276-78 EISENHOWER ROAD
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048
Practice Address - Country:US
Practice Address - Phone:913-250-1111
Practice Address - Fax:913-250-1115
Is Sole Proprietor?:No
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2931235Z00000X
MO02018235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist