Provider Demographics
NPI:1245277425
Name:HUDLOW, HOLLIE ABBOTT (MSSW, LCSW, BCD)
Entity type:Individual
Prefix:
First Name:HOLLIE
Middle Name:ABBOTT
Last Name:HUDLOW
Suffix:
Gender:F
Credentials:MSSW, LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 N. WESTWOOD BLVD.
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-2169
Mailing Address - Country:US
Mailing Address - Phone:573-778-4137
Mailing Address - Fax:
Practice Address - Street 1:1500 N. WESTWOOD BLVD.
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-2169
Practice Address - Country:US
Practice Address - Phone:573-778-4137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0055171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical