Provider Demographics
NPI:1790087773
Name:DECKER, VICTORIA LYNN
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:LYNN
Last Name:DECKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5911 N LEADER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-5625
Mailing Address - Country:US
Mailing Address - Phone:773-332-7382
Mailing Address - Fax:773-305-0915
Practice Address - Street 1:5911 N LEADER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-5625
Practice Address - Country:US
Practice Address - Phone:773-332-7382
Practice Address - Fax:773-305-0915
Is Sole Proprietor?:No
Enumeration Date:2010-11-24
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst