Provider Demographics
NPI:1306034723
Name:HUDSON, CHERYL (ADULT CASE MANAGER)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:HUDSON
Suffix:
Gender:F
Credentials:ADULT CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 WHITLOCK RD
Mailing Address - Street 2:
Mailing Address - City:ALVATON
Mailing Address - State:KY
Mailing Address - Zip Code:42122-9624
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:211 E G L SMITH ST
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:KY
Practice Address - Zip Code:42261-9413
Practice Address - Country:US
Practice Address - Phone:270-526-3877
Practice Address - Fax:270-526-2929
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY270049019Medicaid