Derwin Decker, CADC 1

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

95-04-35 Issued in OR

Practice address

3949 South 6TH Street
Klamath Falls, OR 97603-4746

Phone

(541) 882-1487

Fax

(541) 882-1670

NPI assigned

Jan 20, 2010

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1263945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1263945600000",
    "number": "1619208337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3949 SOUTH 6TH STREET",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "976034746",
            "telephone_number": "541-882-1487",
            "fax_number": "541-882-1670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3949 SOUTH 6TH STREET",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "976034746",
            "telephone_number": "541-882-1487",
            "fax_number": "541-882-1670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DECKER",
        "first_name": "DERWIN",
        "credential": "CADC 1",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-01-20",
        "last_updated": "2010-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "95-04-35",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "129861",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dianndra De la Cruz
• Devree Jesse Dean De la Rosa-Wilder
• Julie Lynn Deane
• Kyle Dean Dearing, OD
• Jennifer Lynne Deatherage, CADCI INTERN
• Shawna Decker
• Stewart Lowell Decker
• Jennifer Deese, LPC
• Donald Alfred Defrang II
• Samantha Joann Defreese

• Addiction (Substance Use Disorder) Counselor in Klamath Falls, OR
• Providers in Klamath Falls, OR by specialty
• Addiction (Substance Use Disorder) Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.