Provider Demographics
NPI:1396456992
Name:HUDSON, KIM L
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:L
Last Name:HUDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4911 LEARNING LN
Mailing Address - Street 2:
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-4533
Mailing Address - Country:US
Mailing Address - Phone:651-360-3202
Mailing Address - Fax:651-369-2833
Practice Address - Street 1:4911 LEARNING LN
Practice Address - Street 2:
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-4533
Practice Address - Country:US
Practice Address - Phone:651-360-3202
Practice Address - Fax:651-369-2833
Is Sole Proprietor?:No
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician