Healthcare Provider Details

I. General information

NPI: 1295148310
Provider Name (Legal Business Name): EMILY HUDSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 NE 87TH AVE STE 460
VANCOUVER WA
98664-1965
US

IV. Provider business mailing address

516 DELEWARE ST. SE 12-100 PHILLIPS WANGSTEEN BUILDING
MINNEAPOLIS MN
55455
US

V. Phone/Fax

Practice location:
  • Phone: 360-514-7771
  • Fax: 360-514-7769
Mailing address:
  • Phone: 126-257-9506
  • Fax: 126-257-9506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number70097
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberOP61437552
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: