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NPI Code Detail

MEDICARE: PRESLEY MONTGOMERY LMSW

MEDICARE: PRESLEY MONTGOMERY LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker099887IA

General Provider Information

NPI Number : 1073265492
Entity Type Code : Individual
Provider Name (Legal Business Name) : PRESLEY MONTGOMERY LMSW
Provider Business Mailing Address
First Line : 3412 CENTER POINT RD NE
Second Line :
City : CEDAR RAPIDS
State : IA
Zip : 52402-5529
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3412 CENTER POINT RD NE
Second Line :
City : CEDAR RAPIDS
State : IA
Zip : 52402-5529
Country : US
Telephone Number : 319-382-8660
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2022
Last Update Date : 01/26/2022

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