Provider Demographics
NPI:1497567358
Name:DECKER, AVA LEIGH
Entity type:Individual
Prefix:
First Name:AVA
Middle Name:LEIGH
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 1:1010 VINE ST APT 102
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-3727
Mailing Address - Country:US
Mailing Address - Phone:715-721-6227
Mailing Address - Fax:
Practice Address - Street 1:3936 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:HOLMEN
Practice Address - State:WI
Practice Address - Zip Code:54636-9187
Practice Address - Country:US
Practice Address - Phone:608-413-4825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician