Provider Demographics
NPI:1245927268
Name:MEREDITH, DAKOTA (LCSW, CADC)
Entity type:Individual
Prefix:
First Name:DAKOTA
Middle Name:
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:DAKOTA
Other - Middle Name:
Other - Last Name:MEREDITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW, CADC
Mailing Address - Street 1:2075 FOXFIELD RD STE 103
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-1402
Mailing Address - Country:US
Mailing Address - Phone:847-457-6730
Mailing Address - Fax:
Practice Address - Street 1:1008 KING JAMES AVE
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-7835
Practice Address - Country:US
Practice Address - Phone:630-220-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490232311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical