Healthcare Provider Details

I. General information

NPI: 1780108217
Provider Name (Legal Business Name): TAYLOR O'NEIL DECKER DSW, MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2017
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2634 MO-109 STE E
WILDWOOD MO
63040
US

IV. Provider business mailing address

2634 MO-109 STE E
WILDWOOD MO
63040
US

V. Phone/Fax

Practice location:
  • Phone: 314-254-3141
  • Fax:
Mailing address:
  • Phone: 314-254-3141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2020022106
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: