MEDICARE: DR. KATHLEEN P DECKER M.D.

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	2084P0800X	Psychiatry Physician	0027276	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0027276	OTHER	WA	MEDICAL LICENSE

General Provider Information

NPI Number	:	1861517989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHLEEN P DECKER M.D.

Provider Business Mailing Address
First Line	:	40 LAKE BELLEVUE DR STE 100
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98005-2480
Country	:	US
Telephone Number	:	425-467-1369
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 LAKE BELLEVUE DR STE 100
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98005-2480
Country	:	US
Telephone Number	:	425-467-1369
Fax Number	:	425-484-6500

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	07/08/2007

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