Healthcare Provider Details

I. General information

NPI: 1730147042
Provider Name (Legal Business Name): ANNE P MONTAGUE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 09/02/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8557 ST LOUIS AVE
SKOKIE IL
60076
US

IV. Provider business mailing address

8557 ST LOUIS AVE
SKOKIE IL
60076
US

V. Phone/Fax

Practice location:
  • Phone: 847-824-7200
  • Fax: 847-824-7300
Mailing address:
  • Phone: 847-824-7200
  • Fax: 847-824-7300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071-005576
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: