| Doctor Name: | EDDIE K WONG |
| NPI Number: | 1013258474 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MSW |
| License Number: | 149005689 |
| Business Practice Address: | 600 Fayette St Peoria, IL - 616033610 |
| Business Phone Number: | 3096718005 |
| Business Fax Number: | 3096718021 |
| Mailing Address: | Po Box 1346, PEORIA |
| State: | IL |
| Postal Code: | 616541346 |
| Phone Number: | 3096718000 |
| Fax Number: | 3096714695 |
| NPI Enumeration Date: | 03/11/2013 |
| NPI Last Update Date: | 03/11/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 149005689 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |