MEDICARE: DAVID LYLE HUDSON LMSW

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	104100000X	Social Worker	12598	AZ

General Provider Information

NPI Number	:	1740788868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID LYLE HUDSON LMSW

Provider Business Mailing Address
First Line	:	6119 N 32ND AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85017-1511
Country	:	US
Telephone Number	:	623-210-3961
Fax Number	:

Provider Business Practice Location Address
First Line	:	6119 N 32ND AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85017-1511
Country	:	US
Telephone Number	:	623-210-3961
Fax Number	:

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

Provider Enumeration Date	:	01/23/2018
Last Update Date	:	01/23/2018

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