Healthcare Provider Details

I. General information

NPI: 1275380263
Provider Name (Legal Business Name): JENNIFER HUDSON SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 SE BAKER WAY
GRESHAM OR
97080-9003
US

IV. Provider business mailing address

1331 NW EASTMAN PKWY
GRESHAM OR
97030-3825
US

V. Phone/Fax

Practice location:
  • Phone: 503-663-7483
  • Fax:
Mailing address:
  • Phone: 503-663-7483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: