Provider Demographics
NPI:1629375043
Name:DECKER, CHERYL S (MS, RD, CD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:S
Last Name:DECKER
Suffix:
Gender:F
Credentials:MS, RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18062 25TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98155-3906
Mailing Address - Country:US
Mailing Address - Phone:425-736-5273
Mailing Address - Fax:206-364-2156
Practice Address - Street 1:18062 25TH AVE NE
Practice Address - Street 2:
Practice Address - City:LAKE FOREST PARK
Practice Address - State:WA
Practice Address - Zip Code:98155-3906
Practice Address - Country:US
Practice Address - Phone:425-736-5273
Practice Address - Fax:206-364-2156
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1001838133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered