Healthcare Provider Details

I. General information

NPI: 1487167318
Provider Name (Legal Business Name): NIEKEMA HUDSON ED.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2017
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1326 MALABAR RD SE STE 1
PALM BAY FL
32907-2502
US

IV. Provider business mailing address

1326 MALABAR RD SE STE 1
PALM BAY FL
32907-2502
US

V. Phone/Fax

Practice location:
  • Phone: 321-655-3588
  • Fax:
Mailing address:
  • Phone: 321-655-3588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH28201
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1912162
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1316423
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSS1824
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: