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General NPI Number Information
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NPI Number | 1477015196
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Entity Type | Individual
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Provider Name | JENNIFER MARIE HUDSON LICSW
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Gender | Female
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Dates
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Enumeration Date | 04/02/2019
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Last Update Date | 09/16/2024
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Provider Practice Location Address
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Address Line | JENNIFER HUDSON 201 INDEPENDENCE DRIVE
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City | COLUMBUS AFB
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State | MS
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Zip | 39710
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Country | US
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Telephone | 662-434-2292
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Fax |
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Provider Business Mailing Address
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Address Line | 201 INDEPENDENCE
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City | COLUMBUS
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State | MS
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Zip | 39710-5300
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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 |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 4213C
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License Number State | AL
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