Provider Demographics
NPI:1225017999
Name:DECKER, AMY B (MS, CGC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:B
Last Name:DECKER
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2799 W GRAND BLVD
Mailing Address - Street 2:MEDICAL GENETICS CFP-4
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2608
Mailing Address - Country:US
Mailing Address - Phone:313-916-1303
Mailing Address - Fax:313-916-1730
Practice Address - Street 1:2799 W GRAND BLVD
Practice Address - Street 2:MEDICAL GENETICS CFP-4
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:313-916-1303
Practice Address - Fax:313-916-1730
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI99079170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS