| Doctor Name: | MR. KEVIN J MONTAGUE |
| NPI Number: | 1992078828 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MS, CSW, SAC, PC-TL |
| License Number: | 8078-120 |
| Business Practice Address: | 100 Polk County Plz Ste 50 Balsam Lake, WI - 548109071 |
| Business Phone Number: | 7154858862 |
| Business Fax Number: | 7154858450 |
| Mailing Address: | 100 Polk County Plz, Ste 50 BALSAM LAKE |
| State: | WI |
| Postal Code: | 548109071 |
| Phone Number: | 7154858862 |
| Fax Number: | 7154858450 |
| NPI Enumeration Date: | 02/23/2012 |
| NPI Last Update Date: | 09/03/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 8078-120 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |