Individual
DEBRA R MONTGOMERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
24493 S INDEPENDENCE BLVD, CRETE, IL 60417-2069
(708) 465-5271
Mailing address
301 N JOE WILSON RD APT 1326, CEDAR HILL, TX 75104-2341
(708) 465-5271
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
854399202
—
IL
Enumeration date
04/20/2021
Last updated
09/04/2021
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