MEDICARE: NAKEIA L HUDSON LISW-S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	I.0700419-SUPV	OH

General Provider Information

NPI Number	:	1104959592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAKEIA L HUDSON LISW-S

Provider Business Mailing Address
First Line	:	200 E CAMPUS VIEW BLVD
Second Line	:	SUITE 200
City	:	COLUMBUS
State	:	OH
Zip	:	43235-4678
Country	:	US
Telephone Number	:	614-259-8879
Fax Number	:	614-413-1537

Provider Business Practice Location Address
First Line	:	200 E CAMPUS VIEW BLVD
Second Line	:	SUITE 200
City	:	COLUMBUS
State	:	OH
Zip	:	43235-4678
Country	:	US
Telephone Number	:	614-259-8879
Fax Number	:	614-413-1537

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	06/25/2020

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