Provider Demographics
NPI:1598219115
Name:HUDSON, JENNIFER (LAC, MACOM, DAOM)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:HUDSON
Suffix:
Gender:F
Credentials:LAC, MACOM, DAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 NE 2ND ST
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-7512
Mailing Address - Country:US
Mailing Address - Phone:503-665-1999
Mailing Address - Fax:
Practice Address - Street 1:915 NE 2ND ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7512
Practice Address - Country:US
Practice Address - Phone:503-665-1999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-11
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist