Provider Demographics
NPI:1891417820
Name:GREGORY, MONTANA (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MONTANA
Middle Name:
Last Name:GREGORY
Suffix:
Gender:
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21920 76TH AVENUE WEST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98926-4831
Mailing Address - Country:US
Mailing Address - Phone:20-665-7640
Mailing Address - Fax:206-519-6672
Practice Address - Street 1:21920 76TH AVENUE WEST
Practice Address - Street 2:SUITE 102
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98926-4831
Practice Address - Country:US
Practice Address - Phone:206-657-6404
Practice Address - Fax:206-519-6672
Is Sole Proprietor?:No
Enumeration Date:2022-09-15
Last Update Date:2025-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL61331448235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist