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General NPI Number Information
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NPI Number | 1861790933
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Entity Type | Organization
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Legal Business Name | JEAN M. MONTY PHD PSYCHOLOGICAL SERVICES LLC
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Dates
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Enumeration Date | 03/14/2011
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Last Update Date | 03/29/2011
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Provider Practice Location Address
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Address Line | 14135 N CEDARBURG RD
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City | MEQUON
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State | WI
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Zip | 53097-1416
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Country | US
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Telephone | 262-377-2006
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Fax | 262-377-5552
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Provider Business Mailing Address
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Address Line | 14135 N CEDARBURG RD
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City | MEQUON
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State | WI
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Zip | 53097-1416
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Country | US
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Telephone | 262-377-2006
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Fax | 262-377-5552
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. JEAN MARIE MONTY
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Credential | PHD
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Telephone | 262-377-2006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1880
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License Number State | WI
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