Healthcare Provider Details

I. General information

NPI: 1841265881
Provider Name (Legal Business Name): SHERRY R MONTGOMERY LSCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 01/31/2022
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5326 NALL AVE
ROELAND PARK KS
66202-1963
US

IV. Provider business mailing address

5326 NALL AVE
ROELAND PARK KS
66202-1963
US

V. Phone/Fax

Practice location:
  • Phone: 913-967-9013
  • Fax:
Mailing address:
  • Phone: 913-967-9013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number003402
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1117
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: