Healthcare Provider Details

I. General information

NPI: 1245706662
Provider Name (Legal Business Name): DAKOTA CHANCE THOMAS HESHELMAN LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2018
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 WINDSOR RD UNIT 15291
LOVES PARK IL
61132-7034
US

IV. Provider business mailing address

1702 WINDSOR RD UNIT #15291
LOVES PARK IL
61132
US

V. Phone/Fax

Practice location:
  • Phone: 815-980-7088
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number180.011840
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: