Healthcare Provider Details

I. General information

NPI: 1790358562
Provider Name (Legal Business Name): MARILYN MONTAGUE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24425 PLYMOUTH RD
REDFORD MI
48239-1616
US

IV. Provider business mailing address

11341 SARASOTA
REDFORD MI
48239-1638
US

V. Phone/Fax

Practice location:
  • Phone: 313-450-0411
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: