Provider Demographics
NPI:1447799879
Name:PEDIGO, MARY E
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:PEDIGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 THIMBLE SHOALS BLVD
Mailing Address - Street 2:STE 4C
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4217
Mailing Address - Country:US
Mailing Address - Phone:757-873-2932
Mailing Address - Fax:757-873-8780
Practice Address - Street 1:729 THIMBLE SHOALS BLVD
Practice Address - Street 2:STE 4C
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4217
Practice Address - Country:US
Practice Address - Phone:757-873-2932
Practice Address - Fax:757-873-8780
Is Sole Proprietor?:No
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202008467235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist