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General NPI Number Information
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NPI Number | 1225457500
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Entity Type | Organization
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Legal Business Name | KRISTINE C HUDZIK
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Dates
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Enumeration Date | 04/15/2014
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Last Update Date | 04/15/2014
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Provider Practice Location Address
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Address Line | 380 E SAINT CHARLES RD UNIT 741
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City | LOMBARD
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State | IL
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Zip | 60148-7831
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Country | US
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Telephone | 858-945-5074
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Fax |
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Provider Business Mailing Address
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Address Line | 380 E SAINT CHARLES RD UNIT 741
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City | LOMBARD
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State | IL
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Zip | 60148-7831
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH PROVIDER
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Name | KRISTINE HUDZIK
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Credential | LCSW
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Telephone | 858-945-5074
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 149015920
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 149015920
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License Number State | IL
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