Provider Demographics
NPI:1801267729
Name:DECKER, NICOLE RENEE (BCBA)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:RENEE
Last Name:DECKER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:RENEE
Other - Last Name:MARTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:256 MONUMENT RD
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60124-3817
Mailing Address - Country:US
Mailing Address - Phone:815-370-8075
Mailing Address - Fax:
Practice Address - Street 1:2422 W MAIN ST UNIT 3C
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-1010
Practice Address - Country:US
Practice Address - Phone:855-444-5664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-19
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst