Provider Demographics
NPI:1558031930
Name:LUDY, KRISTINE MARIE
Entity type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:MARIE
Last Name:LUDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 ROSEBUD ST APT 308
Mailing Address - Street 2:
Mailing Address - City:WALLED LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48390-3403
Mailing Address - Country:US
Mailing Address - Phone:248-704-9922
Mailing Address - Fax:
Practice Address - Street 1:360 ROSEBUD ST APT 308
Practice Address - Street 2:
Practice Address - City:WALLED LAKE
Practice Address - State:MI
Practice Address - Zip Code:48390-3403
Practice Address - Country:US
Practice Address - Phone:248-704-9922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-16
Last Update Date:2024-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness Coach
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No171W00000XOther Service ProvidersContractor
No172A00000XOther Service ProvidersDriverGroup - Multi-Specialty
No251K00000XAgenciesPublic Health or Welfare
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health Aide
No253Z00000XAgenciesIn Home Supportive Care