Provider Demographics
NPI:1164071825
Name:HYDUKOVICH, KARA (LPCC, LADC)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:HYDUKOVICH
Suffix:
Gender:F
Credentials:LPCC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 FORESTVIEW LN N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-5571
Mailing Address - Country:US
Mailing Address - Phone:763-200-1466
Mailing Address - Fax:
Practice Address - Street 1:7200 FORESTVIEW LN N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-5571
Practice Address - Country:US
Practice Address - Phone:763-200-1466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-05
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303374101YA0400X
MN01850101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)