Healthcare Provider Details

I. General information

NPI: 1801355524
Provider Name (Legal Business Name): ANTOINN HUDSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2019
Last Update Date: 08/27/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 MADISON RD
CINCINNATI OH
45206
US

IV. Provider business mailing address

7162 READING RD STE 300
CINCINNATI OH
45237-3899
US

V. Phone/Fax

Practice location:
  • Phone: 513-354-5200
  • Fax: 513-354-7115
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: