Provider Demographics
NPI:1306885421
Name:SCUDDER, JOHN K (EDD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:K
Last Name:SCUDDER
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4140 NEWMAN RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-6742
Mailing Address - Country:US
Mailing Address - Phone:937-288-2505
Mailing Address - Fax:
Practice Address - Street 1:4140 NEWMAN RD
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-6742
Practice Address - Country:US
Practice Address - Phone:937-288-2505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE-0001384101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional