Provider Demographics
NPI:1083148761
Name:DIERKS, DEVIN (LCSW)
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:
Last Name:DIERKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13109 SAND RD
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:IL
Mailing Address - Zip Code:61252-9853
Mailing Address - Country:US
Mailing Address - Phone:563-321-7650
Mailing Address - Fax:
Practice Address - Street 1:13109 SAND RD
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:IL
Practice Address - Zip Code:61252-9853
Practice Address - Country:US
Practice Address - Phone:563-321-7650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-19
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0863051041C0700X
IL149.0210031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical