Provider Demographics
NPI:1851485528
Name:PRICE-DECKER, THERESA JEAN (MS, LCSW)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:JEAN
Last Name:PRICE-DECKER
Suffix:
Gender:F
Credentials:MS, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 ROLLINGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-9187
Mailing Address - Country:US
Mailing Address - Phone:715-282-6107
Mailing Address - Fax:
Practice Address - Street 1:21B S BROWN ST
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-3450
Practice Address - Country:US
Practice Address - Phone:715-362-5437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2124-123101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1029-125OtherLPC LICENSE NUMBER
WI39283400Medicaid
WI2124-123OtherLCSW LICENSE NUMBER