Provider Demographics
NPI:1225838253
Name:HUDSON, KEYSHARA MONAE (LLMSW)
Entity type:Individual
Prefix:
First Name:KEYSHARA
Middle Name:MONAE
Last Name:HUDSON
Suffix:
Gender:
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 44TH ST SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-4276
Mailing Address - Country:US
Mailing Address - Phone:616-389-0788
Mailing Address - Fax:
Practice Address - Street 1:1850 44TH ST SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-4276
Practice Address - Country:US
Practice Address - Phone:616-389-0788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-18
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511158331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical