Provider Demographics
NPI:1205616190
Name:DECKER, KELLY E
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:E
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 1:2714 VINCENT AVE
Mailing Address - Street 2:
Mailing Address - City:MASONVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50654-9205
Mailing Address - Country:US
Mailing Address - Phone:563-920-3961
Mailing Address - Fax:
Practice Address - Street 1:600 STATE ST STE D
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-3371
Practice Address - Country:US
Practice Address - Phone:319-775-0727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-29
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health