Provider Demographics
NPI:1871015958
Name:DAGNER, ASHLEY R (MS, LCPC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:R
Last Name:DAGNER
Suffix:
Gender:
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 S LEE ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-6458
Mailing Address - Country:US
Mailing Address - Phone:815-994-2190
Mailing Address - Fax:
Practice Address - Street 1:706 OGLESBY AVE STE 112
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-4618
Practice Address - Country:US
Practice Address - Phone:815-242-7687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.014734101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health