MEDICARE: DR. COURTNEY L. DIRKSEN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	071-006894	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1637952	OTHER	IL	BCBS OF ILLINOIS

General Provider Information

NPI Number	:	1699815985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COURTNEY L. DIRKSEN PH.D.

Provider Business Mailing Address
First Line	:	855 E GOLF RD STE 2139
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-5225
Country	:	US
Telephone Number	:	847-357-9158
Fax Number	:	847-701-3275

Provider Business Practice Location Address
First Line	:	855 E GOLF RD
Second Line	:	SUITE 2139
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-5222
Country	:	US
Telephone Number	:	847-357-9158
Fax Number	:	847-357-9203

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	04/14/2026

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