Provider Demographics
NPI:1972269645
Name:HUDAK, JENNIFER N (LPC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:N
Last Name:HUDAK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 FIRST AVE STE 511
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1316
Mailing Address - Country:US
Mailing Address - Phone:412-568-3801
Mailing Address - Fax:
Practice Address - Street 1:720 WOODLAND RD
Practice Address - Street 2:
Practice Address - City:BRADFORDWOODS
Practice Address - State:PA
Practice Address - Zip Code:15015-1328
Practice Address - Country:US
Practice Address - Phone:412-568-3801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC013866101YP2500X
DCPRC200001358101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPC013866OtherPA LICENSURE BOARD
DCPRC200001358OtherDISTRICT OF COLUMBIA LICENSURE BOARD