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NPI Code Detail

MEDICARE: SALLY RAY MILLER PIDGE

MEDICARE: SALLY RAY MILLER PIDGE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist2583NC
2174400000XSpecialist4234NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154408607
Entity Type Code : Organization
Provider Name (Legal Business Name) : SALLY RAY MILLER PIDGE
Provider Business Mailing Address
First Line : 2301 CROWN POINT EXECUTIVE DR
Second Line : SUITE E
City : CHARLOTTE
State : NC
Zip : 28227-6725
Country : US
Telephone Number : 704-708-8314
Fax Number : 704-708-8315
Provider Business Practice Location Address
First Line : 2301 CROWN POINT EXECUTIVE DR
Second Line : SUITE E
City : CHARLOTTE
State : NC
Zip : 28227-6725
Country : US
Telephone Number : 704-708-8314
Fax Number : 704-708-8315
Authorized Official
Title or Position : OWNER THERAPIST
Name : MS. SALLY RAY PIDGE
Credential : MED CCC-SLP
Telephone Number : 704-708-8314
Provider Enumeration Date : 11/01/2006
Last Update Date : 10/11/2012

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Directions to “SALLY RAY MILLER PIDGE ” Practice Location

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