Provider Demographics
NPI:1992939144
Name:DECKMAN, DANAE
Entity type:Individual
Prefix:MRS
First Name:DANAE
Middle Name:
Last Name:DECKMAN
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 1:406 S MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:FARMLAND
Mailing Address - State:IN
Mailing Address - Zip Code:47340-9509
Mailing Address - Country:US
Mailing Address - Phone:765-620-8400
Mailing Address - Fax:765-779-4010
Practice Address - Street 1:6145 N COUNTY ROAD 940 W
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:IN
Practice Address - Zip Code:47356-9530
Practice Address - Country:US
Practice Address - Phone:765-620-8400
Practice Address - Fax:765-779-4010
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-02
Last Update Date:2009-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN46001936A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN46001936AOtherIN STATE LICENSE