Individual
MRS. JERRY A MONTGOMERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW ACSW LCSW
Contact information
Practice address
304 DETROIT ST, SUITE A, LA PORTE, IN 46350-2473
(219) 617-0526
Mailing address
226 BARKER RD, MICHIGAN CITY, IN 46360
(219) 617-0526
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34002011A
IN
Other
Enumeration date
11/21/2006
Last updated
03/18/2008
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