Provider Demographics
NPI:1912737313
Name:SUDDUTH, HAZEL IVY
Entity type:Individual
Prefix:
First Name:HAZEL
Middle Name:IVY
Last Name:SUDDUTH
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 1:1116 GARDEN WOODS DRIVE
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244
Mailing Address - Country:US
Mailing Address - Phone:205-855-8002
Mailing Address - Fax:
Practice Address - Street 1:1116 GARDEN WOODS DRIVE
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244
Practice Address - Country:US
Practice Address - Phone:205-855-8002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC04998101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health