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NPI Code Detail

MEDICARE: JALYNN ALICIA MONTGOMERY LMSW

MEDICARE: JALYNN ALICIA MONTGOMERY LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker11214KS
2104100000XSocial Worker2021028578MO

General Provider Information

NPI Number : 1417663410
Entity Type Code : Individual
Provider Name (Legal Business Name) : JALYNN ALICIA MONTGOMERY LMSW
Provider Business Mailing Address
First Line : 4214 E 68TH ST
Second Line :
City : KANSAS CITY
State : MO
Zip : 64132-1448
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6300 N REVERE DR STE 270
Second Line :
City : KANSAS CITY
State : MO
Zip : 64151-3919
Country : US
Telephone Number : 913-735-0577
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2023
Last Update Date : 01/24/2023

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