Provider Demographics
NPI:1306010541
Name:HUDSON, PAMELA ROSE
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:ROSE
Last Name:HUDSON
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 1:32068 GREAT ROAD
Mailing Address - Street 2:
Mailing Address - City:AKELEY
Mailing Address - State:MN
Mailing Address - Zip Code:56433
Mailing Address - Country:US
Mailing Address - Phone:218-652-4530
Mailing Address - Fax:
Practice Address - Street 1:120 MAIN AVE N
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-1810
Practice Address - Country:US
Practice Address - Phone:218-732-7266
Practice Address - Fax:800-422-0863
Is Sole Proprietor?:No
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health