Provider Demographics
NPI:1265244461
Name:DIRKSEN, SHAWN
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:DIRKSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8044 MONTGOMERY RD STE 700
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-2926
Mailing Address - Country:US
Mailing Address - Phone:513-440-3866
Mailing Address - Fax:
Practice Address - Street 1:10831 VERNON RD
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-8540
Practice Address - Country:US
Practice Address - Phone:678-919-0261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator