Healthcare Provider Details

I. General information

NPI: 1033031216
Provider Name (Legal Business Name): MIDWEST FORENSIC NEUROPSYCHOLOGICAL ASSESSMENTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 MAGNAVOX WAY STE 130
FORT WAYNE IN
46804-1553
US

IV. Provider business mailing address

1415 MAGNAVOX WAY STE 130
FORT WAYNE IN
46804-1553
US

V. Phone/Fax

Practice location:
  • Phone: 260-484-4234
  • Fax: 260-483-0836
Mailing address:
  • Phone: 260-484-4234
  • Fax: 260-483-0836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. LARA W. WIELAND
Title or Position: PRESIDENT
Credential:
Phone: 260-224-1798