Provider Demographics
NPI:1659573798
Name:HUDSON, JERI JENENE (LMP)
Entity Type:Individual
Prefix:
First Name:JERI
Middle Name:JENENE
Last Name:HUDSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6711 18TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-1628
Mailing Address - Country:US
Mailing Address - Phone:206-251-2522
Mailing Address - Fax:
Practice Address - Street 1:5410 CALIFORNIA AVE SW
Practice Address - Street 2:SUITE 203
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98136-1562
Practice Address - Country:US
Practice Address - Phone:206-331-3999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00006176225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist