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NPI Code Detail

MEDICARE: ERIC T DECKER SLP

MEDICARE: ERIC T DECKER SLP
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
1235Z00000XSpeech-Language Pathologist1138-154WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578540803
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIC T DECKER SLP
Provider Business Mailing Address
First Line : 6400 INDUSTRIAL LOOP
Second Line :
City : GREENDALE
State : WI
Zip : 53129-2452
Country : US
Telephone Number : 414-423-4100
Fax Number : 414-423-4134
Provider Business Practice Location Address
First Line : 3090 N 53RD ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53210-1617
Country : US
Telephone Number : 414-449-4444
Fax Number : 414-449-4448
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2005
Last Update Date : 07/08/2007

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Directions to “ ERIC T DECKER SLP” Practice Location

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