Healthcare Provider Details

I. General information

NPI: 1497611099
Provider Name (Legal Business Name): ELLIZABETH DECKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2919 CROSSING CT STE 13
CHAMPAIGN IL
61822-5904
US

IV. Provider business mailing address

PO BOX 717
SAVOY IL
61874-0717
US

V. Phone/Fax

Practice location:
  • Phone: 217-861-4063
  • Fax: 217-864-8919
Mailing address:
  • Phone: 217-861-4063
  • Fax: 217-864-8919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: