Provider Demographics
NPI:1760450407
Name:DASENBROOK, NORMAN C (MS, LCPC)
Entity Type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:C
Last Name:DASENBROOK
Suffix:
Gender:M
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3703 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61103-1677
Mailing Address - Country:US
Mailing Address - Phone:815-877-0399
Mailing Address - Fax:815-877-9382
Practice Address - Street 1:3703 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61103-1688
Practice Address - Country:US
Practice Address - Phone:815-877-0399
Practice Address - Fax:815-877-9382
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional