Provider Demographics
NPI:1356547962
Name:WIELAND ASSOCIATES, INC.
Entity type:Organization
Organization Name:WIELAND ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PSYCHOLOGIST
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:PSYD, HSPP
Authorized Official - Phone:260-483-7207
Mailing Address - Street 1:1415 MAGNAVOX WAY
Mailing Address - Street 2:STE: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 1:1415 MAGNAVOX WAY
Practice Address - Street 2:STE: 120
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-1553
Practice Address - Country:US
Practice Address - Phone:260-483-7207
Practice Address - Fax:260-483-0836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041419A103TC0700X
IN103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200260310AMedicaid
IN200360310AMedicaid
ININ1283Medicare PIN
IN200260310AMedicaid