Provider Demographics
NPI:1699814277
Name:HAIG, JAMES R (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:R
Last Name:HAIG
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 W WILLOW KNOLLS DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-8127
Mailing Address - Country:US
Mailing Address - Phone:309-681-5652
Mailing Address - Fax:309-681-5658
Practice Address - Street 1:3020 W WILLOW KNOLLS DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-8127
Practice Address - Country:US
Practice Address - Phone:309-681-5652
Practice Address - Fax:309-681-5658
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILIL 149-005385104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK09882Medicare ID - Type Unspecified