Healthcare Provider Details

I. General information

NPI: 1871015958
Provider Name (Legal Business Name): ASHLEY R. DAGNER MS, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2017
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 S LEE ST
BLOOMINGTON IL
61701-6458
US

IV. Provider business mailing address

805 S LEE ST
BLOOMINGTON IL
61701-6458
US

V. Phone/Fax

Practice location:
  • Phone: 815-242-7687
  • Fax: 217-280-8325
Mailing address:
  • Phone: 815-242-7687
  • Fax: 217-280-8325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.014734
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: