Provider Demographics
NPI:1417143215
Name:HUDSON, PATRICIA MICHELLE (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:MICHELLE
Last Name:HUDSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MRS
Other - First Name:P.
Other - Middle Name:MICHELLE
Other - Last Name:KANIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:170 PERRY ST
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-6345
Mailing Address - Country:US
Mailing Address - Phone:847-760-6809
Mailing Address - Fax:
Practice Address - Street 1:311 N 2ND ST
Practice Address - Street 2:SUITE 304
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1850
Practice Address - Country:US
Practice Address - Phone:224-628-4798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180 003231101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL26-0904366OtherEIN