MEDICARE: DR. JESSICA LYNN HUDSON PH.D.

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	103TC0700X	Clinical Psychologist	071008506	IL

General Provider Information

NPI Number	:	1518249473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA LYNN HUDSON PH.D.

Provider Business Mailing Address
First Line	:	5756 N RIDGE AVE
Second Line	:	UNIT 9
City	:	CHICAGO
State	:	IL
Zip	:	60660-5331
Country	:	US
Telephone Number	:	617-480-5440
Fax Number	:

Provider Business Practice Location Address
First Line	:	5756 N RIDGE AVE
Second Line	:	UNIT 9
City	:	CHICAGO
State	:	IL
Zip	:	60660-5331
Country	:	US
Telephone Number	:	617-480-5440
Fax Number	:

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

Provider Enumeration Date	:	09/15/2011
Last Update Date	:	09/02/2021

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