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General NPI Number Information
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NPI Number | 1104269596
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Entity Type | Individual
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Provider Name | JADA B HUDSON LCPC
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Gender | Female
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Dates
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Enumeration Date | 04/16/2013
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Last Update Date | 04/16/2013
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Provider Practice Location Address
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Address Line | 102 S WASHINGTON ST FL 2
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City | HINSDALE
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State | IL
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Zip | 60521-4073
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Country | US
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Telephone | 630-815-3735
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Fax | 855-727-4855
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Provider Business Mailing Address
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Address Line | PO BOX 1345
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City | SUGAR GROVE
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State | IL
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Zip | 60554-1345
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Country | US
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Telephone | 630-815-3735
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Fax | 855-727-4855
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180006040
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License Number State | IL
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