Provider Demographics
NPI:1477782464
Name:HUDSON, IKEISHA NICOLE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:IKEISHA
Middle Name:NICOLE
Last Name:HUDSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 CRESCENT PLAZA DR
Mailing Address - Street 2:#1213
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-2484
Mailing Address - Country:US
Mailing Address - Phone:281-905-5786
Mailing Address - Fax:
Practice Address - Street 1:1725 CRESCENT PLAZA DR
Practice Address - Street 2:#1213
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-2484
Practice Address - Country:US
Practice Address - Phone:281-905-5786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-10
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103299235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist