Individual
MRS. TINA MARIE MONTGOMERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S. CCC/SLP
Contact information
Practice address
500 W GRANT ST, LAKE CITY, MN 55041-1143
(651) 345-3321
Mailing address
912 S OAK ST, LAKE CITY, MN 55041-1857
(651) 380-1609
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7953
MN
Other
Enumeration date
11/02/2017
Last updated
02/02/2021
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