Provider Demographics
NPI:1750928347
Name:HAGEDORN, DANIELLE MARIE (MS, LPC, SAC, NCC)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:MARIE
Last Name:HAGEDORN
Suffix:
Gender:F
Credentials:MS, LPC, SAC, NCC
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:MARIE
Other - Last Name:LACOST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC - IT; SAC-IT
Mailing Address - Street 1:4330 GOLF TER STE 207
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4688
Mailing Address - Country:US
Mailing Address - Phone:715-514-0493
Mailing Address - Fax:877-855-2504
Practice Address - Street 1:4330 GOLF TER STE 207
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4688
Practice Address - Country:US
Practice Address - Phone:715-514-0493
Practice Address - Fax:877-855-2504
Is Sole Proprietor?:No
Enumeration Date:2019-12-03
Last Update Date:2024-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16520-131101YA0400X
WI8297-125101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1750928347Medicaid