Provider Demographics
NPI:1184212417
Name:RUDNIK, JESSICA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:RUDNIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 FERRY HILL RD
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:MA
Mailing Address - Zip Code:01033-3402
Mailing Address - Country:US
Mailing Address - Phone:845-234-8251
Mailing Address - Fax:
Practice Address - Street 1:54 FERRY HILL RD
Practice Address - Street 2:
Practice Address - City:GRANBY
Practice Address - State:MA
Practice Address - Zip Code:01033-3402
Practice Address - Country:US
Practice Address - Phone:845-234-8251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-03
Last Update Date:2021-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor