Provider Demographics
NPI:1902502230
Name:KUDISCH, JEREMIAH JOSEPH (RMHCI)
Entity Type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:JOSEPH
Last Name:KUDISCH
Suffix:
Gender:M
Credentials:RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7270 HILBURN RD APT 8
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-6392
Mailing Address - Country:US
Mailing Address - Phone:813-638-7582
Mailing Address - Fax:
Practice Address - Street 1:7270 HILBURN RD APT 8
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-6392
Practice Address - Country:US
Practice Address - Phone:813-638-7582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH22943101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health