MEDICARE: MRS. MARTHA PIGAGE M.S. CCC/SLP

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
1	235Z00000X	Speech-Language Pathologist	137759	KY

General Provider Information

NPI Number	:	1346708229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARTHA PIGAGE M.S. CCC/SLP

Provider Business Mailing Address
First Line	:	104 CARRIAGE WAY
Second Line	:
City	:	HOPKINSVILLE
State	:	KY
Zip	:	42240-7939
Country	:	US
Telephone Number	:	270-839-3940
Fax Number	:

Provider Business Practice Location Address
First Line	:	1910 S VIRGINIA ST STE 103
Second Line	:
City	:	HOPKINSVILLE
State	:	KY
Zip	:	42240-6008
Country	:	US
Telephone Number	:	270-707-3454
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2019
Last Update Date	:	03/09/2019

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Directions to “ MRS. MARTHA PIGAGE M.S. CCC/SLP” Practice Location

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