Healthcare Provider Details

I. General information

NPI: 1629998992
Provider Name (Legal Business Name): KAYLA RAE DECKERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 UNIVERSITY AVE E
SAINT PAUL MN
55130-4495
US

IV. Provider business mailing address

435 UNIVERSITY AVE E
SAINT PAUL MN
55130-4495
US

V. Phone/Fax

Practice location:
  • Phone: 651-789-7637
  • Fax: 651-225-0882
Mailing address:
  • Phone: 651-789-7637
  • Fax: 651-225-0882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: