Provider Demographics
NPI:1750653226
Name:DECORAH, KARI B (MS, LPC, SAC-IT)
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:B
Last Name:DECORAH
Suffix:
Gender:F
Credentials:MS, LPC, SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9433 COUNTY RD J
Mailing Address - Street 2:
Mailing Address - City:MINOCQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54548-9318
Mailing Address - Country:US
Mailing Address - Phone:715-356-5377
Mailing Address - Fax:715-356-5378
Practice Address - Street 1:9433 COUNTY RD J
Practice Address - Street 2:
Practice Address - City:MINOCQUA
Practice Address - State:WI
Practice Address - Zip Code:54548-9318
Practice Address - Country:US
Practice Address - Phone:715-356-5377
Practice Address - Fax:715-356-5378
Is Sole Proprietor?:No
Enumeration Date:2012-01-31
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16107-130101YA0400X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100027386Medicaid