Provider Demographics
NPI:1184277675
Name:DECK, CHELSEA ELAINE I (MSW)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:ELAINE
Last Name:DECK
Suffix:I
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 SEWARD ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:MI
Mailing Address - Zip Code:49247-1250
Mailing Address - Country:US
Mailing Address - Phone:517-817-6715
Mailing Address - Fax:
Practice Address - Street 1:1040 S. WINTER STREET
Practice Address - Street 2:SUITE # 1022
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221
Practice Address - Country:US
Practice Address - Phone:517-263-8905
Practice Address - Fax:517-263-7616
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-23
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization