Provider Demographics
NPI:1447476676
Name:HODGSON, PRUDENCE BEATRICE (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:PRUDENCE
Middle Name:BEATRICE
Last Name:HODGSON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12850 S 71ST ST
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-3104
Mailing Address - Country:US
Mailing Address - Phone:480-730-6092
Mailing Address - Fax:480-730-6092
Practice Address - Street 1:12850 S 71ST ST
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-3104
Practice Address - Country:US
Practice Address - Phone:480-730-6092
Practice Address - Fax:480-730-6092
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP#4703235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
01002081OtherASHA CERTIFICATION