Healthcare Provider Details

I. General information

NPI: 1598577520
Provider Name (Legal Business Name): JUDITH DECKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNIE DECKER

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

434 EASTLAND RD
BEREA OH
44017-1217
US

IV. Provider business mailing address

343 W BAGLEY RD
BEREA OH
44017-1370
US

V. Phone/Fax

Practice location:
  • Phone: 844-622-5564
  • Fax:
Mailing address:
  • Phone: 440-260-8300
  • Fax: 440-234-8305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2608629
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: