Organization Name: | SALLY RAY MILLER PIDGE |
NPI Number: | 1154408607 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SALLY RAY PIDGE (OWNER THERAPIST) |
Mailing Address: | 2301 Crown Point Executive Dr Suite E Charlotte |
State: | NC US |
Postal Code: | 282276725 |
Phone Number: | 7047088314 |
Fax Number: | 7047088315 |
NPI Enumeration Date: | 11/01/2006 |
NPI Last Update Date: | 10/11/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 2583 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NC |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |