MEDICARE: KAITLIN DECKARD LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	34946	MN

General Provider Information

NPI Number	:	1144171950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLIN DECKARD LICSW

Provider Business Mailing Address
First Line	:	330 2ND AVE S STE 2001700
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55401-5500
Country	:	US
Telephone Number	:	507-405-5603
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 2ND AVE S STE 2001700
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55401-5500
Country	:	US
Telephone Number	:	507-405-5603
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2026
Last Update Date	:	02/06/2026

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Directions to “ KAITLIN DECKARD LICSW” Practice Location

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