Provider Demographics
NPI:1841253846
Name:HUDSON, JENNY M (LCSW)
Entity type:Individual
Prefix:MS
First Name:JENNY
Middle Name:M
Last Name:HUDSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:M
Other - Last Name:FORKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:405 W 5TH ST
Mailing Address - Street 2:SUITE 521
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-4519
Mailing Address - Country:US
Mailing Address - Phone:714-658-3521
Mailing Address - Fax:714-834-5939
Practice Address - Street 1:405 W 5TH ST
Practice Address - Street 2:SUITE 521
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-4519
Practice Address - Country:US
Practice Address - Phone:714-658-3521
Practice Address - Fax:714-834-5939
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS178511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical