Healthcare Provider Details

I. General information

NPI: 1518018027
Provider Name (Legal Business Name): JACKIE J HUDSON L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

678 COUNTRY CLUB RD
EUGENE OR
97401-2240
US

IV. Provider business mailing address

2245 RIDGEWAY DR
EUGENE OR
97401-6555
US

V. Phone/Fax

Practice location:
  • Phone: 541-684-8101
  • Fax: 541-484-0143
Mailing address:
  • Phone: 541-683-2869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC1414
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: