Provider Demographics
NPI:1093776700
Name:HUDSON, JUDY ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:ANN
Last Name:HUDSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16921 OASIS RD
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607-8687
Mailing Address - Country:US
Mailing Address - Phone:208-860-2345
Mailing Address - Fax:208-459-6921
Practice Address - Street 1:23057 OLD HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83607-7785
Practice Address - Country:US
Practice Address - Phone:208-860-2345
Practice Address - Fax:208-459-6921
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW259121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical