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NPI Code Detail

MEDICARE: JASMINE HUDSON

MEDICARE: JASMINE HUDSON
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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1689164766
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASMINE HUDSON
Provider Business Mailing Address
First Line : 4392 SWEET CHERRY LN
Second Line :
City : KALAMAZOO
State : MI
Zip : 49004-3763
Country : US
Telephone Number : 269-598-5424
Fax Number :
Provider Business Practice Location Address
First Line : 250 MONROE AVE NW STE 400
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49503-2293
Country : US
Telephone Number : 616-888-1120
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2018
Last Update Date : 05/15/2018

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