Provider Demographics
NPI:1275804759
Name:DECKER, KATHLEEN S (RD, LDN, CDE)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:S
Last Name:DECKER
Suffix:
Gender:F
Credentials:RD, LDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 CORPORATE PARKWAY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:CENTER VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18034
Mailing Address - Country:US
Mailing Address - Phone:484-526-7322
Mailing Address - Fax:
Practice Address - Street 1:3701 CORPORATE PKWY
Practice Address - Street 2:SUITE 130
Practice Address - City:CENTER VALLEY
Practice Address - State:PA
Practice Address - Zip Code:18034-8230
Practice Address - Country:US
Practice Address - Phone:484-526-7322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-16
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered