Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | 050 | KS |
N | 102L00000X | Psychologist | 2811 | KS |
N | 103T00000X | Psychologist | 2811 | KS |
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 011 | KS |
NPI | 1548460439 |
---|---|
Provider Name | Susan Montague |
First Address | Salina, KS 67401-2353 |
Second Address | Salina, KS 67401-2697 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2007 |
Last Update Date | 14/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200435200B | (05) | KS |