Provider Demographics
NPI:1699830125
Name:SHIRKOFF, JEAN KATHRYN (MSW)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:KATHRYN
Last Name:SHIRKOFF
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 SW DOGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-2033
Mailing Address - Country:US
Mailing Address - Phone:503-222-1807
Mailing Address - Fax:503-297-0885
Practice Address - Street 1:1942 NW KEARNEY ST STE 12
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1463
Practice Address - Country:US
Practice Address - Phone:503-222-1807
Practice Address - Fax:503-297-0885
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical