Tina Marie Montgomery, M.S. CCC/SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

7953 Issued in MN

Practice address

500 W Grant St
Lake City, MN 55041-1143

Phone

(651) 345-3321

NPI assigned

Nov 2, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1509580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612224000000",
    "number": "1992217673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "912 S OAK ST",
            "city": "LAKE CITY",
            "state": "MN",
            "postal_code": "550411857",
            "telephone_number": "651-380-1609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W GRANT ST",
            "city": "LAKE CITY",
            "state": "MN",
            "postal_code": "550411143",
            "telephone_number": "651-345-3321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTGOMERY",
        "first_name": "TINA",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "M.S. CCC/SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-11-02",
        "last_updated": "2021-02-02",
        "certification_date": "2021-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MN",
            "license": "7953",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tmontgomery88127@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "500 W Grant St",
            "city": "Lake City",
            "state": "MN",
            "country_code": "US",
            "postal_code": "550411143",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Mayo Clinic Health System-Lake City
• Mayo Clinic Health System-Lake City
• Mayo Clinic Hospital-Rochester
• Patience S Mbonifor, RN, DNP
• Srdjan Milosavljevic, PA-C
• Marie Ann Mueske, DDS
• Timothy Vernon Myers, MD
• Heather Nagel
• Laura Anthony O'Rourke, NP-C
• Christian Howard Oeltjen

• All providers in Lake City, MN
• Speech-Language Pathologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2021; 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.