Provider Demographics
NPI:1740526391
Name:WILAND, STEPHEN R (LMSW, ICADC)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:R
Last Name:WILAND
Suffix:
Gender:M
Credentials:LMSW, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 LORI LYNN LN
Mailing Address - Street 2:
Mailing Address - City:WHITMORE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48189-9037
Mailing Address - Country:US
Mailing Address - Phone:734-358-9914
Mailing Address - Fax:
Practice Address - Street 1:202 E WASHINGTON ST
Practice Address - Street 2:# 500
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2017
Practice Address - Country:US
Practice Address - Phone:734-945-4644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-28
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801078883104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker