Provider Demographics
NPI:1629625868
Name:PEDIGO, HARRY E
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:E
Last Name:PEDIGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-2007
Mailing Address - Country:US
Mailing Address - Phone:270-541-1003
Mailing Address - Fax:270-215-0037
Practice Address - Street 1:1001 W 7TH ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-2007
Practice Address - Country:US
Practice Address - Phone:270-541-1003
Practice Address - Fax:270-215-0037
Is Sole Proprietor?:No
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker