Provider Demographics
NPI:1982965596
Name:DECKER, AMBER L
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:L
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 1:120 COUNTY ROAD 1800 N
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IL
Mailing Address - Zip Code:61875-9782
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:120 COUNTY ROAD 1800 N
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IL
Practice Address - Zip Code:61875-9782
Practice Address - Country:US
Practice Address - Phone:217-840-0139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker