Provider Demographics
NPI:1679500136
Name:WILLGALE, JEFFERY JOHN (MSW)
Entity Type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:JOHN
Last Name:WILLGALE
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1622 HENRY PL
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-1921
Mailing Address - Country:US
Mailing Address - Phone:847-263-0094
Mailing Address - Fax:
Practice Address - Street 1:3001 GREENBAY ROAD
Practice Address - Street 2:MAIL CODE 116A
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064
Practice Address - Country:US
Practice Address - Phone:847-688-1900
Practice Address - Fax:224-610-3885
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0109191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149-010919Medicare UPIN