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General NPI Number Information
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NPI Number | 1114341559
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Entity Type | Organization
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Legal Business Name | WIELAND & ASSOCIATES, INC.
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Dates
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Enumeration Date | 02/05/2014
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Last Update Date | 02/05/2014
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Provider Practice Location Address
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Address Line | 11123 PARKVIEW PLAZA DR SUITE 200
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City | FORT WAYNE
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State | IN
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Zip | 46845
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Country | US
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Telephone | 260-672-6510
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Fax | 260-672-6501
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Provider Business Mailing Address
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Address Line | 1415 MAGNAVOX WAY SUITE 120
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City | FORT WAYNE
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State | IN
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Zip | 46804-1553
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Country | US
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Telephone | 260-483-7207
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Fax | 260-483-0836
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEVIN LEE WIELAND
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Credential | PSY. D., HSPP
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Telephone | 260-483-7207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 20041419A
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License Number State | IN
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