Provider Demographics
NPI:1346708229
Name:PIGAGE, MARTHA (MS CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:
Last Name:PIGAGE
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 CARRIAGE WAY
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-7939
Mailing Address - Country:US
Mailing Address - Phone:270-839-3940
Mailing Address - Fax:
Practice Address - Street 1:1910 S VIRGINIA ST STE 103
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-6008
Practice Address - Country:US
Practice Address - Phone:270-707-3454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-09
Last Update Date:2019-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY137759235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist