Provider Demographics
NPI:1083937155
Name:DAGNEN, RENEE DAWN LACASSE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:DAWN LACASSE
Last Name:DAGNEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:MONTESANO
Mailing Address - State:WA
Mailing Address - Zip Code:98563-0366
Mailing Address - Country:US
Mailing Address - Phone:360-249-8421
Mailing Address - Fax:
Practice Address - Street 1:315 W MARCY AVE
Practice Address - Street 2:
Practice Address - City:MONTESANO
Practice Address - State:WA
Practice Address - Zip Code:98563-3618
Practice Address - Country:US
Practice Address - Phone:360-581-7215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-03
Last Update Date:2023-10-26
Deactivation Date:2012-04-13
Deactivation Code:
Reactivation Date:2023-10-11
Provider Licenses
StateLicense IDTaxonomies
WAMA00013096225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist