Jerry A Montgomery, MSW ACSW LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

34002011A Issued in IN

Practice address

304 Detroit St
Suite a
La Porte, IN 46350-2473

Phone

(219) 617-0526

NPI assigned

Nov 21, 2006

Last updated

Mar 18, 2008By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205798400000",
    "number": "1750456356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "226 BARKER RD",
            "city": "MICHIGAN CITY",
            "state": "IN",
            "postal_code": "46360",
            "telephone_number": "219-617-0526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 DETROIT ST",
            "address_2": "SUITE A",
            "city": "LA PORTE",
            "state": "IN",
            "postal_code": "463502473",
            "telephone_number": "219-617-0526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTGOMERY",
        "first_name": "JERRY",
        "middle_name": "A",
        "name_prefix": "Mrs.",
        "credential": "MSW ACSW LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-21",
        "last_updated": "2008-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34002011A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tommy Mislenkov, M.D.
• Sue E Mohlke, BSN, RN, CSA
• Kelly Molenda
• Mitchell Steven Molenda, NP
• Ken Monahan, OTR
• Moore Surgical Associates, P.C.
• Brian G Moore, MD
• Wayne E Moore, MD
• Mary Ann Morgan, R. D.
• Daniel Morrison, ATC

• Clinical Social Worker in La Porte, IN
• Providers in La Porte, IN by specialty
• Clinical Social Worker in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.