Provider Demographics
NPI:1740436740
Name:DECKER, ELIZA EVANGELINE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ELIZA
Middle Name:EVANGELINE
Last Name:DECKER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8014 BETHEL RD
Mailing Address - Street 2:
Mailing Address - City:ARPIN
Mailing Address - State:WI
Mailing Address - Zip Code:54410-9558
Mailing Address - Country:US
Mailing Address - Phone:715-652-2549
Mailing Address - Fax:715-652-2171
Practice Address - Street 1:8014 BETHEL RD
Practice Address - Street 2:
Practice Address - City:ARPIN
Practice Address - State:WI
Practice Address - Zip Code:54410-9558
Practice Address - Country:US
Practice Address - Phone:715-652-2549
Practice Address - Fax:715-652-2171
Is Sole Proprietor?:No
Enumeration Date:2008-08-11
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3071-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist