Provider Demographics
NPI:1942602040
Name:HUDSON, LORA I (LCSW, CSAC)
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:I
Last Name:HUDSON
Suffix:
Gender:F
Credentials:LCSW, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 MENDOTA ST STE 115
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53714-1060
Mailing Address - Country:US
Mailing Address - Phone:608-640-4007
Mailing Address - Fax:608-640-4887
Practice Address - Street 1:1310 MENDOTA ST STE 115
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53714-1060
Practice Address - Country:US
Practice Address - Phone:608-640-4007
Practice Address - Fax:608-640-4887
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-19
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15772-132101YA0400X
WI8304-1231041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
1942602040OtherNPI