Provider Demographics
NPI:1437929890
Name:WIELAND, MADISON LEEANN (LMSW)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:LEEANN
Last Name:WIELAND
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 ALYDAR DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-4756
Mailing Address - Country:US
Mailing Address - Phone:515-777-6026
Mailing Address - Fax:
Practice Address - Street 1:278 ALYDAR DR
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-4756
Practice Address - Country:US
Practice Address - Phone:515-777-6026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA095268104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker