Healthcare Provider Details

I. General information

NPI: 1629997192
Provider Name (Legal Business Name): DOMINIQUE NAGEL
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 TRACY CT
CRYSTAL LAKE IL
60014-6288
US

IV. Provider business mailing address

1312 MULBERRY LN
CARY IL
60013-1853
US

V. Phone/Fax

Practice location:
  • Phone: 815-391-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: