Provider Demographics
NPI:1699043893
Name:HUDSON, TAMMI MAE (LSW)
Entity Type:Individual
Prefix:MRS
First Name:TAMMI
Middle Name:MAE
Last Name:HUDSON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 VIP DRIVE - STAUNTON CLINIC
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090
Mailing Address - Country:US
Mailing Address - Phone:724-935-5177
Mailing Address - Fax:
Practice Address - Street 1:119 VIP DRIVE -STAUNTON CLINIC
Practice Address - Street 2:SUITE 202
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090
Practice Address - Country:US
Practice Address - Phone:724-935-5177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-02
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW125361104100000X
PACW017217104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker