Provider Demographics
NPI:1851198329
Name:MONTGOMERY, JENNIFER LEANNE (CPM, LDM)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LEANNE
Last Name:MONTGOMERY
Suffix:
Gender:
Credentials:CPM, LDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 NE RUSSELL ST STE 204
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-3763
Mailing Address - Country:US
Mailing Address - Phone:503-455-4258
Mailing Address - Fax:
Practice Address - Street 1:333 NE RUSSELL ST STE 204
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-3763
Practice Address - Country:US
Practice Address - Phone:503-455-4258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDEM-LD-10253088176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife