Provider Demographics
NPI:1174826945
Name:WEILAND, KASSIE JO (LIMSW)
Entity Type:Individual
Prefix:MS
First Name:KASSIE
Middle Name:JO
Last Name:WEILAND
Suffix:
Gender:F
Credentials:LIMSW
Other - Prefix:MS
Other - First Name:KASSIE
Other - Middle Name:JO
Other - Last Name:DUNN-WEILAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LIMSW
Mailing Address - Street 1:2737 HOLYOKE LN
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-2202
Mailing Address - Country:US
Mailing Address - Phone:734-474-7259
Mailing Address - Fax:
Practice Address - Street 1:2737 HOLYOKE LN
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-2202
Practice Address - Country:US
Practice Address - Phone:734-474-7259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-16
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401002996101YP2500X
MI68010832301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional