1477228302 NPI number — MRS. CARRIE Y DUDLEY MS, LPC, DP-C

Table of content: MRS. CARRIE Y DUDLEY MS, LPC, DP-C (NPI 1477228302)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477228302 NPI number — MRS. CARRIE Y DUDLEY MS, LPC, DP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUDLEY
Provider First Name:
CARRIE
Provider Middle Name:
Y
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, LPC, DP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477228302
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/17/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 210
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREELAND
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48623-0210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-999-8463
Provider Business Mailing Address Fax Number:
989-266-1440

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8702 WANDERING WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREELAND
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48623-9557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-999-8463
Provider Business Practice Location Address Fax Number:
989-266-1440
Provider Enumeration Date:
08/12/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  6401223431 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X , with the licence number: 6401223431 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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