Provider Demographics
NPI:1295382869
Name:DECKER, ANASTAZIA MARIE (LMSW)
Entity Type:Individual
Prefix:
First Name:ANASTAZIA
Middle Name:MARIE
Last Name:DECKER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3434 TOWNE POINTE DR UNIT 305
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-5343
Mailing Address - Country:US
Mailing Address - Phone:815-762-7242
Mailing Address - Fax:
Practice Address - Street 1:927 N 2ND ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-3750
Practice Address - Country:US
Practice Address - Phone:815-762-7242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0960031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical