Provider Demographics
NPI:1508157652
Name:DECKMAN, ASHLEY MARIE (CGC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MARIE
Last Name:DECKMAN
Suffix:
Gender:F
Credentials:CGC
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:MARIE
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CGC
Mailing Address - Street 1:3435 W BROADWAY AVE
Mailing Address - Street 2:SUITE 1135
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-2969
Mailing Address - Country:US
Mailing Address - Phone:763-520-1422
Mailing Address - Fax:763-520-5875
Practice Address - Street 1:3435 W BROADWAY AVE
Practice Address - Street 2:SUITE 1135
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-2969
Practice Address - Country:US
Practice Address - Phone:763-520-1422
Practice Address - Fax:763-520-5875
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS