Provider Demographics
NPI:1265586903
Name:HUDSON, JULIE MARGARET (LMSW)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:MARGARET
Last Name:HUDSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:MARGARET
Other - Last Name:GRIGAITIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:1350 E WEST MAPLE RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WALLED LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48390-3727
Mailing Address - Country:US
Mailing Address - Phone:248-496-7558
Mailing Address - Fax:248-624-4216
Practice Address - Street 1:1350 E WEST MAPLE RD
Practice Address - Street 2:SUITE 5
Practice Address - City:WALLED LAKE
Practice Address - State:MI
Practice Address - Zip Code:48390-3727
Practice Address - Country:US
Practice Address - Phone:248-496-7558
Practice Address - Fax:248-624-4216
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010700251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1883825Medicaid