Healthcare Provider Details

I. General information

NPI: 1003556887
Provider Name (Legal Business Name): ALBERT MATTHEW DICKAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 NE MOTHER JOSEPH PL
VANCOUVER WA
98664-3200
US

IV. Provider business mailing address

7710 MERCY RD STE 202
OMAHA NE
68124-2353
US

V. Phone/Fax

Practice location:
  • Phone: 360-514-3191
  • Fax: 360-729-3372
Mailing address:
  • Phone: 402-280-4195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberTEP9317
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number70131231
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: