Individual
DR. KEVIN L. WIELAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D., HSPP
Contact information
Practice address
1415 MAGNAVOX WAY, SUITE 120, FORT WAYNE, IN 46804-1565
(260) 483-7207
(260) 483-0836
Mailing address
1415 MAGNAVOX WAY, SUITE 120, FORT WAYNE, IN 46804-1565
(260) 483-7207
(260) 483-0836
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20041419A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200360310A
—
IN
Enumeration date
11/18/2005
Last updated
12/19/2025
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