Healthcare Provider Details

I. General information

NPI: 1902722895
Provider Name (Legal Business Name): MS. KATHY J HUDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3364 MACK AVE
DETROIT MI
48207-2370
US

IV. Provider business mailing address

3364 MACK AVE
DETROIT MI
48207-2370
US

V. Phone/Fax

Practice location:
  • Phone: 313-332-5439
  • Fax: 313-469-1628
Mailing address:
  • Phone: 313-332-5439
  • Fax: 313-469-1628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: