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Organization

WIELAND ASSOCIATES, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. KEVIN LEE WIELAND PSY.D., HSPP (PRESIDENT/PSYCHOLOGIST)
(260) 483-7207
Entity
Organization

Contact information

Practice address
1415 MAGNAVOX WAY, STE: 120, FORT WAYNE, IN 46804-1553
(260) 483-7207
(260) 483-0836
Mailing address
1415 MAGNAVOX WAY, STE:120, FORT WAYNE, IN 46804-1553
(260) 483-7207
(260) 483-0836

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
IN
103TC0700X
Clinical Psychologist
20041419A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200260310A
IN
05
200360310A
IN
Enumeration date
06/21/2007
Last updated
10/28/2016
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