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General NPI Number Information
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NPI Number | 1932530029
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Entity Type | Individual
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Provider Name | STEPHANIE M DECKER LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/27/2013
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Last Update Date | 03/10/2024
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Provider Practice Location Address
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Address Line | 301 MOHAWK TRL
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City | DEFOREST
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State | WI
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Zip | 53532-1021
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Country | US
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Telephone | 812-719-4633
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Fax |
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Provider Business Mailing Address
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Address Line | 1755 STATE ROUTE 1389
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City | HAWESVILLE
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State | KY
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Zip | 42348-6522
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Country | US
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Telephone | 812-719-1401
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 5136
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License Number State | KY
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