Healthcare Provider Details

I. General information

NPI: 1356146799
Provider Name (Legal Business Name): ASHLEY R. DAGNER, LCPC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2025
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: 815-994-2190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY R. DAGNER
Title or Position: OWNER
Credential: MS, LCPC
Phone: 815-242-7687