Provider Demographics
NPI:1972970200
Name:DECKER, JORDAN MARISSA (MED, BCBA, LBA)
Entity type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:MARISSA
Last Name:DECKER
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:MISS
Other - First Name:JORDAN
Other - Middle Name:MARISSA
Other - Last Name:MONEER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, BCBA, LBA
Mailing Address - Street 1:3400 STATE ST STE 750
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-5861
Mailing Address - Country:US
Mailing Address - Phone:971-273-7502
Mailing Address - Fax:
Practice Address - Street 1:3400 STATE ST STE 750
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-5861
Practice Address - Country:US
Practice Address - Phone:971-273-7502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-21
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst