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NPI Code Detail

MEDICARE: DR. KEVIN L. WIELAND PSY.D., HSPP

MEDICARE: DR. KEVIN L. WIELAND PSY.D., HSPP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist20041419AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1497737902
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KEVIN L. WIELAND PSY.D., HSPP
Provider Business Mailing Address
First Line : 1415 MAGNAVOX WAY
Second Line : SUITE 120
City : FORT WAYNE
State : IN
Zip : 46804-1565
Country : US
Telephone Number : 260-483-7207
Fax Number : 260-483-0836
Provider Business Practice Location Address
First Line : 1415 MAGNAVOX WAY
Second Line : SUITE 120
City : FORT WAYNE
State : IN
Zip : 46804-1565
Country : US
Telephone Number : 260-483-7207
Fax Number : 260-483-0836
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/18/2005
Last Update Date : 12/19/2025

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