Provider Demographics
NPI:1558330209
Name:DECKER, TRICIA E (MS CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:E
Last Name:DECKER
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:TRICIA
Other - Middle Name:E
Other - Last Name:KLESNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:215 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032
Mailing Address - Country:US
Mailing Address - Phone:501-269-0642
Mailing Address - Fax:
Practice Address - Street 1:6917 GEYER SPRINGS RD
Practice Address - Street 2:STE 1S
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209
Practice Address - Country:US
Practice Address - Phone:501-570-4004
Practice Address - Fax:501-570-4003
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP1922235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR146145721Medicaid
AR5X815OtherBLUE CROSS