Healthcare Provider Details

I. General information

NPI: 1144769274
Provider Name (Legal Business Name): MARTHA HODGE M.S., BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2017
Last Update Date: 09/20/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 NATCHEZ TRACE AVE STE 201
BOWLING GREEN KY
42103-7947
US

IV. Provider business mailing address

676 GRINDSTONE RD
CLARKSON KY
42726-7200
US

V. Phone/Fax

Practice location:
  • Phone: 917-410-7526
  • Fax:
Mailing address:
  • Phone: 270-230-7738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number310959
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number296863
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: