Provider Demographics
NPI:1134637168
Name:WALAG, EUGENE JOSEPH III (LSW)
Entity Type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:JOSEPH
Last Name:WALAG
Suffix:III
Gender:M
Credentials:LSW
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Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF VETERANS AFFAIRS - ILLIANA (EW122)
Mailing Address - Street 2:1900 E. MAIN ST.
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-5100
Mailing Address - Country:US
Mailing Address - Phone:217-554-5527
Mailing Address - Fax:217-554-4090
Practice Address - Street 1:DEPARTMENT OF VETERANS AFFAIRS - ILLIANA (EW122)
Practice Address - Street 2:1900 E. MAIN ST.
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-5100
Practice Address - Country:US
Practice Address - Phone:217-554-5527
Practice Address - Fax:217-554-4090
Is Sole Proprietor?:No
Enumeration Date:2018-01-11
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL150102957104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker