Provider Demographics
NPI:1114341559
Name:WIELAND & ASSOCIATES, INC.
Entity Type:Organization
Organization Name:WIELAND & ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WIELAND
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D, HSPP
Authorized Official - Phone:260-483-7207
Mailing Address - Street 1:1415 MAGNAVOX WAY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-1553
Mailing Address - Country:US
Mailing Address - Phone:260-483-7207
Mailing Address - Fax:260-483-0836
Practice Address - Street 1:11123 PARKVIEW PLAZA DR
Practice Address - Street 2:SUITE 200
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845
Practice Address - Country:US
Practice Address - Phone:260-672-6510
Practice Address - Fax:260-672-6501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041419A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200360310AMedicaid
IN200360310AMedicaid