MEDICARE: NYCOLE MONTANO MS CCC-SLP

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
1	235Z00000X	Speech-Language Pathologist	656191	UT

General Provider Information

NPI Number	:	1902271554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NYCOLE MONTANO MS CCC-SLP

Provider Business Mailing Address
First Line	:	12556 WISSANT LN
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-2723
Country	:	US
Telephone Number	:	505-330-9774
Fax Number	:

Provider Business Practice Location Address
First Line	:	12556 WISSANT LN
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-2723
Country	:	US
Telephone Number	:	505-330-9774
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2015
Last Update Date	:	12/08/2015

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Directions to “ NYCOLE MONTANO MS CCC-SLP” Practice Location

Language	Start Address	Practice Location

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