MEDICARE: MRS. JEAN KATHRYN SHIRKOFF MSW

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	1041C0700X	Clinical Social Worker	1314	OR

General Provider Information

NPI Number	:	1699830125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JEAN KATHRYN SHIRKOFF MSW

Provider Business Mailing Address
First Line	:	4000 SW DOGWOOD LN
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97225-2033
Country	:	US
Telephone Number	:	503-222-1807
Fax Number	:	503-297-0885

Provider Business Practice Location Address
First Line	:	1942 NW KEARNEY ST STE 12
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97209-1463
Country	:	US
Telephone Number	:	503-222-1807
Fax Number	:	503-297-0885

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

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	07/08/2007

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