Provider Demographics
NPI:1306963327
Name:HUDSON, PATRICIA M (LSW, DT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:HUDSON
Suffix:
Gender:F
Credentials:LSW, DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 PLEASANT PLACE #4C
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-3167
Mailing Address - Country:US
Mailing Address - Phone:708-435-3148
Mailing Address - Fax:
Practice Address - Street 1:1025 PLEASANT PLACE #4C
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-3167
Practice Address - Country:US
Practice Address - Phone:708-435-3148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
IL150-00-7764104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist