MEDICARE: MS. VICTORIA LYNN DECKER

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1790087773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VICTORIA LYNN DECKER

Provider Business Mailing Address
First Line	:	5911 N LEADER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-5625
Country	:	US
Telephone Number	:	773-332-7382
Fax Number	:	773-305-0915

Provider Business Practice Location Address
First Line	:	5911 N LEADER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-5625
Country	:	US
Telephone Number	:	773-332-7382
Fax Number	:	773-305-0915

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

Provider Enumeration Date	:	11/24/2010
Last Update Date	:	07/12/2013

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