Provider Demographics
NPI:1104269596
Name:HUDSON, JADA B (LCPC)
Entity type:Individual
Prefix:
First Name:JADA
Middle Name:B
Last Name:HUDSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1345
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60554-1345
Mailing Address - Country:US
Mailing Address - Phone:630-815-3735
Mailing Address - Fax:855-727-4855
Practice Address - Street 1:102 S WASHINGTON ST FL 2
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-4073
Practice Address - Country:US
Practice Address - Phone:630-815-3735
Practice Address - Fax:855-727-4855
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006040101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional