Active NPI
Vivian Diane Hudson-Davis, DEVELOPMENTAL THERAP
- Developmental Therapist
- Glenwood, IL
National Provider Identifier
1295048817
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmental Therapist
- License
- 1972388
- Practice address
- 242 S Dante Ave
Glenwood, IL 60425-2058 - Phone
- (708) 757-3560
- Fax
- (708) 757-4799
- NPI assigned
- Jul 24, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmental Therapist | 222Q00000X | 1972388 | IL | Primary |
Addresses
Primary practice location
242 S Dante Ave
Glenwood, IL 60425-2058
Mailing address
242 S Dante Ave
Glenwood, IL 60425-2058
Phone (708) 757-3560
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1972388 | IL | MD | Developmental Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1279929600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1279929600000",
"number": "1295048817",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "242 S DANTE AVE",
"city": "GLENWOOD",
"state": "IL",
"postal_code": "604252058",
"telephone_number": "708-757-3560",
"fax_number": "708-757-4799"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "242 S DANTE AVE",
"city": "GLENWOOD",
"state": "IL",
"postal_code": "604252058",
"telephone_number": "708-757-3560",
"fax_number": "708-757-4799"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HUDSON-DAVIS",
"first_name": "VIVIAN",
"middle_name": "DIANE",
"credential": "DEVELOPMENTAL THERAP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-07-24",
"last_updated": "2010-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": "IL",
"license": "1972388",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glenwood, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.