Provider Demographics
NPI:1134525348
Name:DECKER-SHAH, LEANN THERESA (MS, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:LEANN
Middle Name:THERESA
Last Name:DECKER-SHAH
Suffix:
Gender:F
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:LEANN
Other - Middle Name:THERESA
Other - Last Name:DECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10230 N BARR AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-1125
Mailing Address - Country:US
Mailing Address - Phone:386-209-1001
Mailing Address - Fax:
Practice Address - Street 1:10230 N BARR AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-1125
Practice Address - Country:US
Practice Address - Phone:386-209-1001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-15
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst