MEDICARE: ALYSSA MONTGOMERY

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
1	104100000X	Social Worker	33013882A	IN

General Provider Information

NPI Number	:	1306778485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA MONTGOMERY

Provider Business Mailing Address
First Line	:	6655 E US HIGHWAY 36
Second Line	:
City	:	AVON
State	:	IN
Zip	:	46123-8923
Country	:	US
Telephone Number	:	888-714-1927
Fax Number	:

Provider Business Practice Location Address
First Line	:	7625 NEW AUGUSTA RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-2296
Country	:	US
Telephone Number	:	317-387-5900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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Directions to “ ALYSSA MONTGOMERY ” Practice Location

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