Provider Demographics
NPI:1851467500
Name:HUDSON, PAUL F III (CADC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:F
Last Name:HUDSON
Suffix:III
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 FRONT STREET
Mailing Address - Street 2:SUITE 30
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-1667
Mailing Address - Country:US
Mailing Address - Phone:920-885-2780
Mailing Address - Fax:
Practice Address - Street 1:200 FRONT STREET
Practice Address - Street 2:SUITE 30
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-1667
Practice Address - Country:US
Practice Address - Phone:920-885-2780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1593101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39340600Medicaid