Provider Demographics
NPI:1740582857
Name:TUDERS, AUBREY KRISTEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AUBREY
Middle Name:KRISTEN
Last Name:TUDERS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 E MILHAM AVE
Mailing Address - Street 2:ZACH DUGGAR
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-3049
Mailing Address - Country:US
Mailing Address - Phone:612-300-0533
Mailing Address - Fax:
Practice Address - Street 1:1617 E MILHAM AVE
Practice Address - Street 2:ZACH DUGGAR
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-3049
Practice Address - Country:US
Practice Address - Phone:612-300-0533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-22
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016914103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical