Individual
MIA IRENE DECKERT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
23663 PARK ST, DEARBORN, MI 48124-2547
(313) 400-9342
Mailing address
2959 ROOSEVELT ST, DEARBORN, MI 48124-3621
(313) 770-7642
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
7401001818
MI
103K00000X
Behavior Analyst
COBA.01190
OH
106E00000X
Assistant Behavior Analyst
—
—
106S00000X
Behavior Technician
—
—
Other
Enumeration date
01/11/2019
Last updated
08/05/2024
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