Provider Demographics
NPI:1932530029
Name:DECKER, STEPHANIE M (LCSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:M
Last Name:DECKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 STATE ROUTE 1389
Mailing Address - Street 2:
Mailing Address - City:HAWESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42348-6522
Mailing Address - Country:US
Mailing Address - Phone:812-719-1401
Mailing Address - Fax:
Practice Address - Street 1:301 MOHAWK TRL
Practice Address - Street 2:
Practice Address - City:DEFOREST
Practice Address - State:WI
Practice Address - Zip Code:53532-1021
Practice Address - Country:US
Practice Address - Phone:812-719-4633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-27
Last Update Date:2024-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY51361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical