Healthcare Provider Details

I. General information

NPI: 1174782015
Provider Name (Legal Business Name): ELIZABETH KIM MONTGOMERY AU.D., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 05/05/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 GAUSE BLVD E STE 200
SLIDELL LA
70461-5425
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 985-646-4400
  • Fax: 985-646-4408
Mailing address:
  • Phone: 985-646-4400
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number3610
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number3610
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: