Healthcare Provider Details

I. General information

NPI: 1659281665
Provider Name (Legal Business Name): DAKODA HANSON LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

3600 S WATER TOWER PL
MOUNT VERNON IL
62864-6589
US

IV. Provider business mailing address

221 CHATHAM DR
SALEM IL
62881-3952
US

V. Phone/Fax

Practice location:
  • Phone: 618-244-0212
  • Fax: 618-244-0535
Mailing address:
  • Phone: 618-246-0080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.033351
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: