Most Relevant Information
Provider Data
| NPI Number: | 1003570656 |
| Provider Name: | ANDREA MONTGOMERY |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 10/28/2021 |
| Last Updated: | 10/28/2021 |
Provider Practice Location
12355 DEPAUL DR.
BRIDGETON
MO
63044
Practice Location Phone/Fax
| Phone: | 3143447200 |
| Fax: |
Provider Mailing Location
1430 OLIVE ST STE 400
SAINT LOUIS
MO
631032303
Provider Mailing Phone/Fax
| Phone: | 3142063700 |
| Fax: |