Provider Demographics
NPI:1487167318
Name:HUDSON, NIEKEMA (EDD)
Entity type:Individual
Prefix:DR
First Name:NIEKEMA
Middle Name:
Last Name:HUDSON
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 IRWIN ST STE 251
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-7316
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2412 IRWIN ST STE 251
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-7316
Practice Address - Country:US
Practice Address - Phone:321-952-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2023-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1912162103TS0200X
FL1316423103TS0200X
FLSS1824103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1912162OtherILLINOIS STATE BOARD OF EDUCATION
FLSS1824OtherFLORIDA DEPARTMENT OF HEALTH
FL1316423OtherSTATE OF FLORIDA DEPARTMENT OF EDUCATION