Provider Demographics
NPI:1932672060
Name:WIELAND, MARTHA MARY (BSW, LLBSW)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:MARY
Last Name:WIELAND
Suffix:
Gender:F
Credentials:BSW, LLBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5805 CEDAR LAKE RD
Mailing Address - Street 2:
Mailing Address - City:OSCODA
Mailing Address - State:MI
Mailing Address - Zip Code:48750-9499
Mailing Address - Country:US
Mailing Address - Phone:616-916-5372
Mailing Address - Fax:
Practice Address - Street 1:5805 CEDAR LAKE RD
Practice Address - Street 2:
Practice Address - City:OSCODA
Practice Address - State:MI
Practice Address - Zip Code:48750-9499
Practice Address - Country:US
Practice Address - Phone:616-916-5372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802088848104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker