MEDICARE: ALISSA L DECOTEAU LICSW

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	1041C0700X	Clinical Social Worker	25665	MN
2	1041C0700X	Clinical Social Worker	4245	ND

General Provider Information

NPI Number	:	1841589561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISSA L DECOTEAU LICSW

Provider Business Mailing Address
First Line	:	2632 47TH ST S STE 102
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58104-8571
Country	:	US
Telephone Number	:	701-893-8068
Fax Number	:

Provider Business Practice Location Address
First Line	:	2632 47TH ST S STE 102
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58104-8571
Country	:	US
Telephone Number	:	701-893-8068
Fax Number	:

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

Provider Enumeration Date	:	04/04/2011
Last Update Date	:	05/26/2026

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Directions to “ ALISSA L DECOTEAU LICSW” Practice Location

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