=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073304325
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JODY LYNN DECKER PPSC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2025
-----------------------------------------------------
Last Update Date | 05/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5715 SKVARLA AVE
-----------------------------------------------------
City | MCCLELLAN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95652-2424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-286-5161
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7724 COMMONWEALTH DR
-----------------------------------------------------
City | ANTELOPE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95843-2312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-289-1194
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YS0200X
-----------------------------------------------------
Taxonomy Name | School Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------