Provider Demographics
NPI:1922201250
Name:HUDSON, SAM J
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:J
Last Name:HUDSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 S US HIGHWAY 131
Mailing Address - Street 2:
Mailing Address - City:THREE RIVERS
Mailing Address - State:MI
Mailing Address - Zip Code:49093-8831
Mailing Address - Country:US
Mailing Address - Phone:269-858-3311
Mailing Address - Fax:
Practice Address - Street 1:1803 WHITES RD
Practice Address - Street 2:SUITE 1-B
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-2883
Practice Address - Country:US
Practice Address - Phone:269-373-7585
Practice Address - Fax:269-363-7588
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000464231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist