Healthcare Provider Details

I. General information

NPI: 1710812318
Provider Name (Legal Business Name): JAMIE DECKER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2146 DIVISION AVE S
GRAND RAPIDS MI
49507-3031
US

IV. Provider business mailing address

25 CARLTON AVE SE APT 101
GRAND RAPIDS MI
49506-1680
US

V. Phone/Fax

Practice location:
  • Phone: 616-262-0535
  • Fax:
Mailing address:
  • Phone: 616-262-0535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: JAMIE DECKER L DECKER
Title or Position: OWNER
Credential: MA, MLP, CAADC
Phone: 616-262-0535