MEDICARE: DAKOTA CHANCE THOMAS HESHELMAN LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	180.011840	IL

General Provider Information

NPI Number	:	1245706662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAKOTA CHANCE THOMAS HESHELMAN LCPC

Provider Business Mailing Address
First Line	:	1702 WINDSOR RD UNIT #15291
Second Line	:
City	:	LOVES PARK
State	:	IL
Zip	:	61132
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1702 WINDSOR RD UNIT 15291
Second Line	:
City	:	LOVES PARK
State	:	IL
Zip	:	61132-7034
Country	:	US
Telephone Number	:	815-980-7088
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2018
Last Update Date	:	03/09/2026

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