MEDICARE: EMMALEE DECKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	C.2305529	OH

General Provider Information

NPI Number	:	1518787316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMALEE DECKER

Provider Business Mailing Address
First Line	:	915 CROGHAN ST
Second Line	:
City	:	FREMONT
State	:	OH
Zip	:	43420-2337
Country	:	US
Telephone Number	:	419-458-3100
Fax Number	:	567-250-2152

Provider Business Practice Location Address
First Line	:	915 CROGHAN ST
Second Line	:
City	:	FREMONT
State	:	OH
Zip	:	43420-2337
Country	:	US
Telephone Number	:	419-458-3100
Fax Number	:	567-250-2152

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2024
Last Update Date	:	10/15/2024

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Directions to “ EMMALEE DECKER ” Practice Location

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