MEDICARE: ALYSSA MARIE DECREMER

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1558219667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA MARIE DECREMER

Provider Business Mailing Address
First Line	:	2363 BADGER STREET
Second Line	:
City	:	MARQUETTE
State	:	MI
Zip	:	49855
Country	:	US
Telephone Number	:	906-273-1121
Fax Number	:	906-225-6706

Provider Business Practice Location Address
First Line	:	2363 BADGER STREET
Second Line	:
City	:	MARQUETTE
State	:	MI
Zip	:	49855
Country	:	US
Telephone Number	:	906-273-1121
Fax Number	:	906-225-6706

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

Provider Enumeration Date	:	03/17/2026
Last Update Date	:	03/17/2026

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