Healthcare Provider Details

I. General information

NPI: 1821628686
Provider Name (Legal Business Name): AMY KATHERINE DAGENAIS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2020
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2353 BADGER STREET
MARQUETTE MI
49855-2303
US

IV. Provider business mailing address

2353 BADGER STREET
MARQUETTE MI
49855-2303
US

V. Phone/Fax

Practice location:
  • Phone: 906-273-1121
  • Fax: 906-225-6706
Mailing address:
  • Phone: 906-273-1121
  • Fax: 906-225-6706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401223118
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: