Provider Demographics
NPI:1538441910
Name:MONTGOMERY, BEVERLY JOY (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:JOY
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:19 MUZZEY ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-5256
Mailing Address - Country:US
Mailing Address - Phone:781-862-4500
Mailing Address - Fax:781-862-4599
Practice Address - Street 1:19 MUZZEY ST
Practice Address - Street 2:SUITE 202
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-5256
Practice Address - Country:US
Practice Address - Phone:781-862-4500
Practice Address - Fax:781-862-4599
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6717235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist