Provider Demographics
NPI:1487606133
Name:DECKER, TODD (MS, CCC-A)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:DECKER
Suffix:
Gender:M
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 18TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-8630
Mailing Address - Country:US
Mailing Address - Phone:605-882-1591
Mailing Address - Fax:605-753-5591
Practice Address - Street 1:405 18TH AVE NE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-8630
Practice Address - Country:US
Practice Address - Phone:605-882-1591
Practice Address - Fax:605-753-5591
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD39231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5832550Medicaid
SD22679OtherSIOUX VALLEY HEALTH PLAN
SDS6795Medicare ID - Type Unspecified