Provider Demographics
NPI:1730671546
Name:DECKER, JAMIE LYNN (MA, LLP)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN
Last Name:DECKER
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 LYON ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-5607
Mailing Address - Country:US
Mailing Address - Phone:616-451-2039
Mailing Address - Fax:
Practice Address - Street 1:1099 44TH ST SW STE 103
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509-4473
Practice Address - Country:US
Practice Address - Phone:269-459-1818
Practice Address - Fax:269-365-9951
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361007511103T00000X
MI6301016596103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist