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Individual

HEATHER M HUDSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
101 W KIRKWOOD AVE STE 222, BLOOMINGTON, IN 47404-6133
(812) 361-1234
Mailing address
101 W KIRKWOOD AVE STE 222, BLOOMINGTON, IN 47404-6133
(812) 361-1234

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34005660A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
IN1464001
MEDICARE PTAN
Enumeration date
04/09/2013
Last updated
11/25/2014
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