Healthcare Provider Details

I. General information

NPI: 1093645681
Provider Name (Legal Business Name): ERICA MICHELLE MONTGOMERY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2026
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10979 REED HARTMAN HWY STE 228
BLUE ASH OH
45242-2882
US

IV. Provider business mailing address

10979 REED HARTMAN HWY STE 228
BLUE ASH OH
45242-2882
US

V. Phone/Fax

Practice location:
  • Phone: 513-549-4172
  • Fax:
Mailing address:
  • Phone: 513-549-4172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.0031813
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: