Provider Demographics
NPI:1861517989
Name:DECKER, KATHLEEN P (MD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:P
Last Name:DECKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 LAKE BELLEVUE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2480
Mailing Address - Country:US
Mailing Address - Phone:425-467-1369
Mailing Address - Fax:
Practice Address - Street 1:40 LAKE BELLEVUE DR STE 100
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2480
Practice Address - Country:US
Practice Address - Phone:425-467-1369
Practice Address - Fax:425-484-6500
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00272762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0027276OtherMEDICAL LICENSE
WA0027276OtherMEDICAL LICENSE