Provider Demographics
NPI:1457701070
Name:DAGENAIS, KELSEY M (LCPC)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:M
Last Name:DAGENAIS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:M
Other - Last Name:CONLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:5912 EL MORRO LN
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-1922
Mailing Address - Country:US
Mailing Address - Phone:708-560-3069
Mailing Address - Fax:
Practice Address - Street 1:5912 EL MORRO LN
Practice Address - Street 2:
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-1922
Practice Address - Country:US
Practice Address - Phone:708-560-3069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180010357101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional