Provider Demographics
NPI:1861679326
Name:HUDSON, THAIS V (DN)
Entity Type:Individual
Prefix:DR
First Name:THAIS
Middle Name:V
Last Name:HUDSON
Suffix:
Gender:F
Credentials:DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:PARK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60466-1027
Mailing Address - Country:US
Mailing Address - Phone:708-601-3545
Mailing Address - Fax:
Practice Address - Street 1:306 JACKSON ST
Practice Address - Street 2:
Practice Address - City:PARK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60466-1027
Practice Address - Country:US
Practice Address - Phone:708-601-3545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL181.000334172P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172P00000XOther Service ProvidersNaprapath