Provider Demographics
NPI:1356146799
Name:ASHLEY R. DAGNER, LCPC, PLLC
Entity type:Organization
Organization Name:ASHLEY R. DAGNER, LCPC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:DAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCPC
Authorized Official - Phone:815-994-2190
Mailing Address - Street 1:805 S LEE ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-6458
Mailing Address - Country:US
Mailing Address - Phone:815-994-2190
Mailing Address - Fax:
Practice Address - Street 1:706 OGLESBY AVE STE 112
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-4618
Practice Address - Country:US
Practice Address - Phone:815-242-7687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)