Provider Demographics
NPI:1427769751
Name:WALLEN-HAAG, SYLVIA
Entity type:Individual
Prefix:
First Name:SYLVIA
Middle Name:
Last Name:WALLEN-HAAG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 420
Mailing Address - Street 2:
Mailing Address - City:CRAIG
Mailing Address - State:AK
Mailing Address - Zip Code:99921-0420
Mailing Address - Country:US
Mailing Address - Phone:907-401-0759
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 420
Practice Address - Street 2:
Practice Address - City:CRAIG
Practice Address - State:AK
Practice Address - Zip Code:99921-0420
Practice Address - Country:US
Practice Address - Phone:907-826-3891
Practice Address - Fax:907-826-3892
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-07
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health