Provider Demographics
NPI:1780103226
Name:HUDSON, RICK K (MSE, MS, LPC-IT)
Entity type:Individual
Prefix:
First Name:RICK
Middle Name:K
Last Name:HUDSON
Suffix:
Gender:M
Credentials:MSE, MS, LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6117 MONONA DR STE 1
Mailing Address - Street 2:
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53716-4304
Mailing Address - Country:US
Mailing Address - Phone:608-223-1506
Mailing Address - Fax:608-223-1745
Practice Address - Street 1:6117 MONONA DR STE 1
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-4304
Practice Address - Country:US
Practice Address - Phone:608-223-1506
Practice Address - Fax:608-223-1745
Is Sole Proprietor?:No
Enumeration Date:2017-09-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3647-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional