Provider Demographics
NPI:1235712787
Name:CUDNEY, CAMERON RUSSELL
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:RUSSELL
Last Name:CUDNEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1738 HILLSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-2247
Mailing Address - Country:US
Mailing Address - Phone:269-370-2850
Mailing Address - Fax:
Practice Address - Street 1:460 W CROOKED LAKE DR
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-8930
Practice Address - Country:US
Practice Address - Phone:269-370-2850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010861301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical