Healthcare Provider Details

I. General information

NPI: 1215265491
Provider Name (Legal Business Name): ROSE MONTGOMERY, M.S., CCC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2009
Last Update Date: 11/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 CARLISLE BLVD NE ST. 201-E
ALBUQUERQUE NM
87110-5660
US

IV. Provider business mailing address

4708 HANNETT AVE NE
ALBUQUERQUE NM
87110-5016
US

V. Phone/Fax

Practice location:
  • Phone: 505-255-6141
  • Fax: 505-262-1903
Mailing address:
  • Phone: 505-268-5098
  • Fax: 505-262-1903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number140
License Number StateNM

VIII. Authorized Official

Name: MS. ROSE INES MONTGOMERY
Title or Position: SPEECH/LANGUAGE PATHOLOGIST
Credential: M.S.
Phone: 505-268-5098