MEDICARE: ANNE P. MONTAGUE PHD

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	103TC0700X	Clinical Psychologist		IL

General Provider Information

NPI Number	:	1730147042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE P. MONTAGUE PHD

Provider Business Mailing Address
First Line	:	241 GOLF MILL CTR
Second Line	:	SUITE 726
City	:	NILES
State	:	IL
Zip	:	60714-1224
Country	:	US
Telephone Number	:	847-824-7200
Fax Number	:	847-824-7300

Provider Business Practice Location Address
First Line	:	241 GOLF MILL CTR
Second Line	:	SUITE 726
City	:	NILES
State	:	IL
Zip	:	60714-1224
Country	:	US
Telephone Number	:	847-824-7200
Fax Number	:	847-824-7300

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	07/08/2007

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