Provider Demographics
NPI:1962614230
Name:ANNE P. MONTAGUE PC
Entity type:Organization
Organization Name:ANNE P. MONTAGUE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:P
Authorized Official - Last Name:MONTAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:847-824-7200
Mailing Address - Street 1:241 GOLF MILL CTR
Mailing Address - Street 2:SUITE 726
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-1224
Mailing Address - Country:US
Mailing Address - Phone:847-824-7200
Mailing Address - Fax:847-824-7300
Practice Address - Street 1:241 GOLF MILL CTR
Practice Address - Street 2:SUITE 726
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-1224
Practice Address - Country:US
Practice Address - Phone:847-824-7200
Practice Address - Fax:847-824-7300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01636055OtherBLUECROSS BLUESHIELD