Healthcare Provider Details

I. General information

NPI: 1649185083
Provider Name (Legal Business Name): MR. ROBERT HUDAK ROBERT HUDAK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 OAK DR
GALLIPOLIS OH
45631-1413
US

IV. Provider business mailing address

258 OAK DR
GALLIPOLIS OH
45631-1413
US

V. Phone/Fax

Practice location:
  • Phone: 740-446-0198
  • Fax:
Mailing address:
  • Phone: 740-446-0198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: